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
0450
null
revCode
Emergency Room General
worker comp
Medicaid
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
Medicare Part A
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
Medicare Part B
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
POS
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
PPO
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
Workers Comp
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
0460
null
revCode
Pulmonary Function General
aetna
EPO
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
HMO
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
Medicaid
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
Medicare Part A
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
Medicare Part B
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
POS
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
PPO
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna
Workers Comp
O
450.50
52.61
166.95
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
EPO
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
HMO
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
Medicaid
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
Medicare Part A
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
Medicare Part B
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
POS
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
PPO
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
aetna - medicare advantage
Workers Comp
O
450.50
52.61
234.21
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
EPO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
HMO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
Medicaid
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
Medicare Part A
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
Medicare Part B
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
POS
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
PPO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield
Workers Comp
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
EPO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
HMO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
Medicaid
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
Medicare Part A
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
Medicare Part B
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
POS
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
PPO
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
blue cross blue shield - medicare advantage
Workers Comp
O
450.50
52.61
52.61
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
EPO
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
HMO
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
Medicaid
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
Medicare Part A
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
Medicare Part B
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
POS
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
PPO
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
cigna
Workers Comp
O
450.50
52.61
137.46
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
EPO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
HMO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
Medicaid
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
Medicare Part A
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
Medicare Part B
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
POS
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
PPO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
humana - medicare advantage
Workers Comp
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
EPO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
HMO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
Medicaid
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
Medicare Part A
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
Medicare Part B
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
POS
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
PPO
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
tricare
Workers Comp
O
450.50
52.61
224.22
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
EPO
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
HMO
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
Medicaid
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
Medicare Part A
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
Medicare Part B
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
POS
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
PPO
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
united healthcare
Workers Comp
O
450.50
52.61
268.71
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
EPO
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
EPO
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
HMO
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
HMO
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicaid
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicaid
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicare Part A
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicare Part A
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicare Part B
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Medicare Part B
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
POS
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
POS
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
PPO
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
PPO
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Workers Comp
I
130.38
34.43
34.43
34.43
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
va
Workers Comp
O
450.50
52.61
234.20
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
EPO
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
HMO
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
Medicaid
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
Medicare Part A
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
Medicare Part B
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
POS
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
PPO
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0460
null
revCode
Pulmonary Function General
webtpa
Workers Comp
O
450.50
52.61
736.47
736.47
270.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
EPO
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
EPO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
HMO
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
HMO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicaid
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicaid
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicare Part A
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicare Part A
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicare Part B
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Medicare Part B
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
POS
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
POS
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
PPO
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
PPO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Workers Comp
I
1777.46
500.94
1030.93
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna
Workers Comp
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
aetna - medicare advantage
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
EPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
HMO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
Medicaid
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
Medicare Part A
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
Medicare Part B
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
POS
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
PPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield
Workers Comp
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
EPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
HMO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
Medicaid
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
Medicare Part A
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
Medicare Part B
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
POS
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
PPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
blue cross blue shield - medicare advantage
Workers Comp
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
EPO
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
EPO
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
HMO
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
HMO
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicaid
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicaid
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicare Part A
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicare Part A
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicare Part B
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Medicare Part B
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
POS
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
POS
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
PPO
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
PPO
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Workers Comp
I
1777.46
500.94
1692.82
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
cigna
Workers Comp
O
1777.46
426.62
1222.22
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
geha
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
EPO
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
HMO
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicaid
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicare Part A
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicare Part B
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
POS
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
PPO
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Workers Comp
I
1777.46
500.94
1360.64
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
humana - medicare advantage
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
tricare
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
EPO
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
HMO
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicaid
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicare Part A
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicare Part B
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
POS
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
PPO
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Workers Comp
I
1777.46
500.94
1269.61
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
united healthcare - medicare advantage
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
EPO
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
EPO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
HMO
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
HMO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicaid
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicaid
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicare Part A
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicare Part A
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicare Part B
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Medicare Part B
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
POS
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
POS
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
PPO
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
PPO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Workers Comp
I
1777.46
500.94
500.94
1692.82
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
va
Workers Comp
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
EPO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
HMO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
Medicaid
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
Medicare Part A
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
Medicare Part B
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
POS
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
PPO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
webtpa
Workers Comp
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0480
null
revCode
Cardiology General
worker comp
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
EPO
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
HMO
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
Medicaid
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
Medicare Part A
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
Medicare Part B
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
POS
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
PPO
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield
Workers Comp
O
2664.52
477.40
664.39
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
EPO
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
HMO
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
Medicaid
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
Medicare Part A
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
Medicare Part B
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
POS
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
PPO
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0481
null
revCode
Cardiology Cardiac cath lab
blue cross blue shield - medicare advantage
Workers Comp
O
2664.52
477.40
477.40
664.39
1598.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
EPO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
HMO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
Medicaid
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
Medicare Part A
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
Medicare Part B
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
POS
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
PPO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna
Workers Comp
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
EPO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
HMO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
Medicaid
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
Medicare Part A
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
Medicare Part B
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
POS
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
PPO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
aetna - medicare advantage
Workers Comp
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
EPO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
HMO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
Medicaid
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
Medicare Part A
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
Medicare Part B
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
POS
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
PPO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield
Workers Comp
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
EPO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
HMO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
Medicaid
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
Medicare Part A
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
Medicare Part B
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
POS
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
PPO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
blue cross blue shield - medicare advantage
Workers Comp
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
EPO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
HMO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
Medicaid
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
Medicare Part A
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
Medicare Part B
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
POS
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
PPO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
cigna
Workers Comp
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
humana - medicare advantage
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
EPO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
HMO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
Medicaid
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
Medicare Part A
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
Medicare Part B
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
POS
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
PPO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
medica
Workers Comp
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
tricare
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
EPO
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
HMO
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicaid
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicare Part A
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicare Part B
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
POS
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
PPO
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Workers Comp
I
934.37
282.79
629.64
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
united healthcare - medicare advantage
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
EPO
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
EPO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
HMO
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
HMO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicaid
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicaid
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicare Part A
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicare Part A
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicare Part B
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Medicare Part B
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
POS
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
POS
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
PPO
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
PPO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Workers Comp
I
934.37
282.79
282.79
629.64
560.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
va
Workers Comp
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
EPO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
HMO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
Medicaid
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
Medicare Part A
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
Medicare Part B
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
POS
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
PPO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
webtpa
Workers Comp
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0482
null
revCode
Cardiology Stress test
worker comp
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
EPO
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
HMO
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
Medicaid
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
Medicare Part A
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
Medicare Part B
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
POS
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
PPO
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna
Workers Comp
O
167.48
48.42
48.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
EPO
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
HMO
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
Medicaid
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
Medicare Part A
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
Medicare Part B
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
POS
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
PPO
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
aetna - medicare advantage
Workers Comp
O
167.48
48.42
81.42
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
EPO
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
HMO
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
Medicaid
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
Medicare Part A
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
Medicare Part B
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
POS
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
PPO
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
blue cross blue shield - medicare advantage
Workers Comp
O
167.48
48.42
160.04
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
EPO
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
HMO
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
Medicaid
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
Medicare Part A
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
Medicare Part B
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
POS
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
PPO
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
cigna
Workers Comp
O
167.48
48.42
74.31
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
EPO
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
HMO
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
Medicaid
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
Medicare Part A
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
Medicare Part B
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
POS
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
PPO
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
humana - medicare advantage
Workers Comp
O
167.48
48.42
54.88
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
EPO
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
HMO
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
Medicaid
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
Medicare Part A
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
Medicare Part B
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
POS
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
PPO
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
tricare
Workers Comp
O
167.48
48.42
53.57
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
EPO
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
HMO
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
Medicaid
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
Medicare Part A
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
Medicare Part B
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
POS
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
PPO
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare
Workers Comp
O
167.48
48.42
59.63
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
EPO
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
HMO
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
Medicaid
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
Medicare Part A
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
Medicare Part B
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
POS
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
PPO
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
united healthcare - medicare advantage
Workers Comp
O
167.48
48.42
100.65
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
EPO
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
HMO
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
Medicaid
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
Medicare Part A
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
Medicare Part B
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
POS
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
PPO
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
va
Workers Comp
O
167.48
48.42
105.16
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
EPO
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
HMO
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
Medicaid
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
Medicare Part A
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
Medicare Part B
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
POS
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
PPO
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
webtpa
Workers Comp
O
167.48
48.42
128.18
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
EPO
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
HMO
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
Medicaid
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
Medicare Part A
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
Medicare Part B
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
POS
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
PPO
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0510
null
revCode
Clinic General
worker comp
Workers Comp
O
167.48
48.42
453.15
453.15
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
EPO
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
HMO
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
Medicaid
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
Medicare Part A
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
Medicare Part B
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
POS
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
PPO
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
humana - medicare advantage
Workers Comp
O
1620.74
506.06
506.06
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
EPO
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
HMO
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
Medicaid
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
Medicare Part A
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
Medicare Part B
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
POS
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
PPO
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
tricare
Workers Comp
O
1620.74
506.06
516.39
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
EPO
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
HMO
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
Medicaid
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
Medicare Part A
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
Medicare Part B
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
POS
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
PPO
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0511
null
revCode
Clinic Chronic pain center
webtpa
Workers Comp
O
1620.74
506.06
1001.00
1001.00
972.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
EPO
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
HMO
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
Medicaid
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
Medicare Part A
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
Medicare Part B
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
POS
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
PPO
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0516
null
revCode
Clinic Urgent care clinic
webtpa
Workers Comp
O
83.74
58.62
58.62
58.62
50.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
EPO
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
HMO
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
Medicaid
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
Medicare Part A
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
Medicare Part B
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
POS
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
PPO
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
aetna
Workers Comp
O
154.00
67.21
67.21
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
EPO
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
HMO
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
Medicaid
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
Medicare Part A
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
Medicare Part B
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
POS
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
PPO
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0521
null
revCode
Freestanding Clinic Clinic visit by member toRHC/FQHC
united healthcare - medicare advantage
Workers Comp
O
154.00
67.21
93.84
93.84
92.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
EPO
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
HMO
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
Medicaid
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
Medicare Part A
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
Medicare Part B
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
POS
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
PPO
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield
Workers Comp
I
20860.67
7941.01
7985.60
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
EPO
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
HMO
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
Medicaid
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
POS
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
PPO
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
20860.67
7941.01
10800.09
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
EPO
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
HMO
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
Medicaid
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
Medicare Part A
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
Medicare Part B
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
POS
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
PPO
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
054
null
ms-drg
nervous system neoplasms with mcc
humana - medicare advantage
Workers Comp
I
20860.67
7941.01
7941.01
10800.09
12516.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
EPO
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
HMO
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
Medicaid
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
Medicare Part A
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
Medicare Part B
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
POS
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
PPO
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
cigna
Workers Comp
O
590.42
109.96
512.72
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
EPO
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
HMO
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
Medicaid
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
Medicare Part A
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
Medicare Part B
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
POS
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
PPO
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
humana - medicare advantage
Workers Comp
O
590.42
109.96
109.96
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
EPO
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
HMO
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
Medicaid
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
Medicare Part A
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
Medicare Part B
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
POS
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
PPO
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
tricare
Workers Comp
O
590.42
109.96
113.37
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
EPO
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
HMO
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
Medicaid
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
Medicare Part A
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
Medicare Part B
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
POS
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
PPO
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare
Workers Comp
O
590.42
109.96
229.76
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
EPO
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
HMO
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
Medicaid
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
Medicare Part A
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
Medicare Part B
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
POS
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
PPO
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
united healthcare - medicare advantage
Workers Comp
O
590.42
109.96
443.77
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
EPO
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
HMO
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
Medicaid
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
Medicare Part A
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
Medicare Part B
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
POS
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
PPO
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
va
Workers Comp
O
590.42
109.96
184.42
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
EPO
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
HMO
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
Medicaid
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
Medicare Part A
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
Medicare Part B
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
POS
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
PPO
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0540
null
revCode
Ambulance General
webtpa
Workers Comp
O
590.42
109.96
816.94
816.94
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
EPO
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
HMO
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
Medicaid
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
Medicare Part A
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
Medicare Part B
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
POS
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
PPO
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
tricare
Workers Comp
I
33418.60
15524.93
16428.84
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
EPO
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
HMO
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
Medicaid
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
Medicare Part A
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
Medicare Part B
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
POS
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
PPO
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
056
null
ms-drg
degenerative nervous system disorders with mcc
va
Workers Comp
I
33418.60
15524.93
15524.93
16428.84
20051.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
EPO
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
HMO
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
Medicaid
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
Medicare Part A
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
Medicare Part B
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
POS
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
PPO
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield
Workers Comp
I
31499.29
8327.46
11812.42
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
EPO
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
HMO
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
Medicaid
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
POS
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
PPO
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
31499.29
8327.46
12577.89
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
EPO
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
HMO
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
Medicaid
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
Medicare Part A
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
Medicare Part B
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
POS
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
PPO
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
humana - medicare advantage
Workers Comp
I
31499.29
8327.46
8327.46
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
EPO
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
HMO
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
Medicaid
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
Medicare Part A
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
Medicare Part B
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
POS
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
PPO
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
tricare
Workers Comp
I
31499.29
8327.46
15290.30
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
EPO
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
HMO
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
Medicaid
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
Medicare Part A
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
Medicare Part B
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
POS
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
PPO
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
057
null
ms-drg
degenerative nervous system disorders without mcc
webtpa
Workers Comp
I
31499.29
8327.46
20442.96
20442.96
18899.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
EPO
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
HMO
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
Medicaid
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
Medicare Part A
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
Medicare Part B
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
POS
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
PPO
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
aetna - medicare advantage
Workers Comp
I
31378.64
10511.34
10511.34
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
EPO
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
HMO
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
Medicaid
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
Medicare Part A
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
Medicare Part B
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
POS
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
PPO
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
058
null
ms-drg
multiple sclerosis and cerebellar ataxia with mcc
humana - medicare advantage
Workers Comp
I
31378.64
10511.34
12664.50
12664.50
18827.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
EPO
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
HMO
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
Medicaid
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
Medicare Part A
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
Medicare Part B
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
POS
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
PPO
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
aetna
Workers Comp
I
22852.02
7096.75
7184.68
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
EPO
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
HMO
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
Medicaid
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
Medicare Part A
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
Medicare Part B
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
POS
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
PPO
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
blue cross blue shield
Workers Comp
I
22852.02
7096.75
13971.33
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
EPO
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
HMO
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
Medicaid
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
Medicare Part A
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
Medicare Part B
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
POS
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
PPO
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
humana - medicare advantage
Workers Comp
I
22852.02
7096.75
7096.75
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
EPO
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
HMO
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
Medicaid
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
Medicare Part A
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
Medicare Part B
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
POS
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
PPO
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
059
null
ms-drg
multiple sclerosis and cerebellar ataxia with cc
webtpa
Workers Comp
I
22852.02
7096.75
27963.58
27963.58
13711.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
EPO
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
HMO
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
Medicaid
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
Medicare Part A
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
Medicare Part B
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
POS
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
PPO
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
blue cross blue shield
Workers Comp
I
16763.13
6428.29
9741.39
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
EPO
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
HMO
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
Medicaid
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
Medicare Part A
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
Medicare Part B
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
POS
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
PPO
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
060
null
ms-drg
multiple sclerosis and cerebellar ataxia without cc/mcc
va
Workers Comp
I
16763.13
6428.29
6428.29
9741.39
10057.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
EPO
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
HMO
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
Medicaid
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
Medicare Part A
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
Medicare Part B
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
POS
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
PPO
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
061
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with mcc
blue cross blue shield
Workers Comp
I
60141.62
24644.06
24644.06
24644.06
36084.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
EPO
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
HMO
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
Medicaid
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
Medicare Part A
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
Medicare Part B
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
POS
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
PPO
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna
Workers Comp
O
2719.05
203.81
1577.05
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
EPO
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
HMO
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
Medicaid
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
POS
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
PPO
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
406.52
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
EPO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
HMO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
Medicaid
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
Medicare Part A
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
Medicare Part B
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
POS
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
PPO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield
Workers Comp
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
517.17
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
EPO
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
HMO
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
Medicaid
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
Medicare Part A
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
Medicare Part B
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
POS
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
PPO
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
cigna
Workers Comp
O
2719.05
203.81
1924.06
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
EPO
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
EPO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
HMO
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
HMO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicaid
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicaid
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicare Part A
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicare Part B
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
POS
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
POS
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
PPO
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
PPO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Workers Comp
I
2719.05
704.16
1972.26
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
humana - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
EPO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
HMO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
Medicaid
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
Medicare Part A
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
Medicare Part B
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
POS
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
PPO
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
tricare
Workers Comp
O
2719.05
203.81
206.45
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
EPO
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
EPO
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
HMO
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
HMO
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicaid
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicaid
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicare Part A
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicare Part A
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicare Part B
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Medicare Part B
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
POS
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
POS
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
PPO
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
PPO
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Workers Comp
I
2719.05
704.16
1912.77
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
united healthcare
Workers Comp
O
2719.05
203.81
2034.07
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
EPO
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
EPO
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
HMO
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
HMO
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicaid
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicaid
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicare Part A
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicare Part A
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicare Part B
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Medicare Part B
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
POS
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
POS
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
PPO
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
PPO
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Workers Comp
I
2719.05
704.16
704.16
1972.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
va
Workers Comp
O
2719.05
203.81
203.81
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
EPO
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
HMO
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
Medicaid
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
Medicare Part A
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
Medicare Part B
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
POS
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
PPO
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0610
null
revCode
Magnetic Resonance Technology (MRT) General
webtpa
Workers Comp
O
2719.05
203.81
1903.34
2034.07
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
EPO
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
EPO
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
HMO
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
HMO
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicaid
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicaid
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicare Part A
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicare Part A
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicare Part B
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Medicare Part B
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
POS
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
POS
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
PPO
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
PPO
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Workers Comp
I
2719.05
290.04
788.53
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna
Workers Comp
O
2719.05
203.81
1577.05
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
EPO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
HMO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
Medicaid
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
POS
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
PPO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
EPO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
HMO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
Medicaid
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
Medicare Part A
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
Medicare Part B
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
POS
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
PPO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield
Workers Comp
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
811.86
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
EPO
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
HMO
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
Medicaid
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
Medicare Part A
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
Medicare Part B
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
POS
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
PPO
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
cigna
Workers Comp
O
2719.05
203.81
1924.06
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
EPO
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
HMO
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
Medicaid
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
Medicare Part A
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
Medicare Part B
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
POS
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
PPO
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
healthchoice
Workers Comp
O
2719.05
203.81
539.65
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
EPO
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
EPO
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
HMO
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
HMO
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicaid
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicaid
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicare Part A
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicare Part B
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
POS
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
POS
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
PPO
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
PPO
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Workers Comp
I
2719.05
290.04
290.04
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
humana - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
EPO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
HMO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
Medicaid
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
Medicare Part A
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
Medicare Part B
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
POS
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
PPO
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
tricare
Workers Comp
O
2719.05
203.81
326.02
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
EPO
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
EPO
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
HMO
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
HMO
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicaid
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicaid
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicare Part A
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicare Part A
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicare Part B
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Medicare Part B
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
POS
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
POS
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
PPO
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
PPO
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Workers Comp
I
2719.05
290.04
1718.26
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare
Workers Comp
O
2719.05
203.81
2577.39
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
EPO
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
HMO
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
Medicaid
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
Medicare Part A
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
Medicare Part B
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
POS
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
PPO
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
united healthcare - medicare advantage
Workers Comp
O
2719.05
203.81
326.12
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
EPO
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
EPO
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
HMO
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
HMO
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicaid
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicaid
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicare Part A
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicare Part A
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicare Part B
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Medicare Part B
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
POS
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
POS
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
PPO
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
PPO
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Workers Comp
I
2719.05
290.04
674.69
1718.26
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
va
Workers Comp
O
2719.05
203.81
203.81
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
EPO
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
HMO
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
Medicaid
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
Medicare Part A
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
Medicare Part B
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
POS
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
PPO
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0611
null
revCode
Magnetic Resonance Technology (MRT) Brain/brain stem
webtpa
Workers Comp
O
2719.05
203.81
1927.88
2577.39
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
EPO
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
HMO
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
Medicaid
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
Medicare Part A
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
Medicare Part B
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
POS
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
PPO
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna
Workers Comp
O
2719.05
203.81
1527.85
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
EPO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
HMO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
Medicaid
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
Medicare Part A
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
Medicare Part B
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
POS
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
PPO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield
Workers Comp
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
458.10
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
EPO
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
HMO
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
Medicaid
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
Medicare Part A
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
Medicare Part B
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
POS
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
PPO
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna
Workers Comp
O
2719.05
203.81
1815.30
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
cigna - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
EPO
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
HMO
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
Medicaid
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
Medicare Part A
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
Medicare Part B
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
POS
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
PPO
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
healthchoice
Workers Comp
O
2719.05
203.81
372.20
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
humana - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
EPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
HMO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
Medicaid
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
Medicare Part A
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
Medicare Part B
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
POS
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
PPO
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
tricare
Workers Comp
O
2719.05
203.81
206.45
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
EPO
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
HMO
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
Medicaid
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
Medicare Part A
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
Medicare Part B
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
POS
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
PPO
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
united healthcare
Workers Comp
O
2719.05
203.81
1942.19
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
EPO
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
HMO
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
Medicaid
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
Medicare Part A
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
Medicare Part B
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
POS
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
PPO
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
va
Workers Comp
O
2719.05
203.81
203.81
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
EPO
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
HMO
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
Medicaid
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
Medicare Part A
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
Medicare Part B
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
POS
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
PPO
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
webtpa
Workers Comp
O
2719.05
203.81
1858.03
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
EPO
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
HMO
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
Medicaid
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
Medicare Part A
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
Medicare Part B
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
POS
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
PPO
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0612
null
revCode
Magnetic Resonance Technology (MRT) Spinal cord/spine
worker comp
Workers Comp
O
2719.05
203.81
1812.71
1942.19
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
EPO
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
HMO
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
Medicaid
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
Medicare Part A
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
Medicare Part B
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
POS
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
PPO
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
blue cross blue shield
Workers Comp
I
45199.82
11989.83
31007.63
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
EPO
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
HMO
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
Medicaid
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
Medicare Part A
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
Medicare Part B
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
POS
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
PPO
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
humana - medicare advantage
Workers Comp
I
45199.82
11989.83
11989.83
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
EPO
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
HMO
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
Medicaid
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
Medicare Part A
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
Medicare Part B
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
POS
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
PPO
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
062
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent with cc
tricare
Workers Comp
I
45199.82
11989.83
12826.44
31007.63
27119.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
EPO
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
HMO
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
Medicaid
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
Medicare Part A
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
Medicare Part B
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
POS
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
PPO
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0623
null
revCode
Medical/Surgical Supplies - Extension of 027X Surgical Dressings
blue cross blue shield
Workers Comp
O
88.48
45.47
45.47
45.47
53.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
EPO
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
HMO
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
Medicaid
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
Medicare Part A
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
Medicare Part B
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
POS
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
PPO
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
blue cross blue shield
Workers Comp
I
41154.45
10931.44
18190.13
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
EPO
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
HMO
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
Medicaid
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
Medicare Part A
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
Medicare Part B
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
POS
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
PPO
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
063
null
ms-drg
ischemic stroke precerebral occlusion or transient ischemia with thrombolytic agent without cc/mcc
tricare
Workers Comp
I
41154.45
10931.44
10931.44
18190.13
24692.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
EPO
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
EPO
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
HMO
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
HMO
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicaid
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicaid
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicare Part A
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicare Part A
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicare Part B
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Medicare Part B
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
POS
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
POS
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
PPO
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
PPO
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Workers Comp
I
78.27
13.11
52.40
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna
Workers Comp
O
56.18
8.97
8.97
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
EPO
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
HMO
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
Medicaid
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
Medicare Part A
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
Medicare Part B
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
POS
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
PPO
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
aetna - medicare advantage
Workers Comp
O
56.18
8.97
9.19
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
EPO
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
HMO
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
Medicaid
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
Medicare Part A
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
Medicare Part B
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
POS
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
PPO
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield
Workers Comp
O
56.18
8.97
10.93
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
EPO
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
HMO
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
Medicaid
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
Medicare Part A
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
Medicare Part B
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
POS
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
PPO
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
blue cross blue shield - medicare advantage
Workers Comp
O
56.18
8.97
11.12
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
EPO
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
EPO
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
HMO
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
HMO
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicaid
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicaid
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicare Part A
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicare Part A
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicare Part B
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Medicare Part B
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
POS
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
POS
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
PPO
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
PPO
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Workers Comp
I
78.27
13.11
34.07
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
cigna
Workers Comp
O
56.18
8.97
14.53
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
EPO
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
HMO
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
Medicaid
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
Medicare Part A
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
Medicare Part B
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
POS
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
PPO
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
geha
Workers Comp
O
56.18
8.97
23.73
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
EPO
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
HMO
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
Medicaid
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
Medicare Part A
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
Medicare Part B
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
POS
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
PPO
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
healthchoice
Workers Comp
O
56.18
8.97
11.31
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
EPO
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
EPO
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
HMO
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
HMO
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicaid
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicaid
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicare Part A
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicare Part A
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicare Part B
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Medicare Part B
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
POS
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
POS
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
PPO
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
PPO
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Workers Comp
I
78.27
13.11
44.42
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
humana - medicare advantage
Workers Comp
O
56.18
8.97
15.81
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
EPO
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
HMO
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
Medicaid
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
Medicare Part A
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
Medicare Part B
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
POS
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
PPO
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
medica
Workers Comp
O
56.18
8.97
30.03
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
EPO
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
HMO
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
Medicaid
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
Medicare Part A
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
Medicare Part B
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
POS
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
PPO
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
tricare
Workers Comp
O
56.18
8.97
20.66
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
EPO
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
EPO
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
HMO
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
HMO
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicaid
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicaid
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicare Part A
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicare Part A
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicare Part B
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Medicare Part B
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
POS
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
POS
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
PPO
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
PPO
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Workers Comp
I
78.27
13.11
65.03
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare
Workers Comp
O
56.18
8.97
29.42
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
EPO
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
HMO
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
Medicaid
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
Medicare Part A
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
Medicare Part B
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
POS
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
PPO
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
united healthcare - medicare advantage
Workers Comp
O
56.18
8.97
19.00
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
EPO
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
EPO
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
HMO
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
HMO
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicaid
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicaid
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicare Part A
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicare Part A
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicare Part B
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Medicare Part B
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
POS
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
POS
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
PPO
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
PPO
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Workers Comp
I
78.27
13.11
13.11
65.03
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
va
Workers Comp
O
56.18
8.97
24.87
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
EPO
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
HMO
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
Medicaid
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
Medicare Part A
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
Medicare Part B
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
POS
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
PPO
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
webtpa
Workers Comp
O
56.18
8.97
710.49
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
EPO
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
HMO
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
Medicaid
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
Medicare Part A
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
Medicare Part B
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
POS
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
PPO
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0636
null
revCode
Pharmacy - Extension of 025X Drugs requiring detailed coding
worker comp
Workers Comp
O
56.18
8.97
24.90
710.49
33.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
EPO
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
HMO
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
Medicaid
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
Medicare Part A
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
Medicare Part B
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
POS
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
PPO
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
aetna
Workers Comp
I
45160.75
11094.73
28232.59
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
EPO
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
HMO
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
Medicaid
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
Medicare Part A
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
Medicare Part B
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
POS
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
PPO
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
blue cross blue shield
Workers Comp
I
45160.75
11094.73
20163.66
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
EPO
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
HMO
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
Medicaid
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
Medicare Part A
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
Medicare Part B
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
POS
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
PPO
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
064
null
ms-drg
intracranial hemorrhage or cerebral infarction with mcc
humana - medicare advantage
Workers Comp
I
45160.75
11094.73
11094.73
28232.59
27096.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
EPO
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
HMO
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
Medicaid
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
Medicare Part A
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
Medicare Part B
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
POS
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
PPO
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna
Workers Comp
I
22376.55
5642.29
11909.55
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
EPO
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
HMO
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
Medicaid
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
Medicare Part A
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
Medicare Part B
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
POS
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
PPO
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
aetna - medicare advantage
Workers Comp
I
22376.55
5642.29
6621.26
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
EPO
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
HMO
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
Medicaid
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
Medicare Part A
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
Medicare Part B
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
POS
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
PPO
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
blue cross blue shield
Workers Comp
I
22376.55
5642.29
10730.14
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
EPO
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
HMO
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
Medicaid
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
Medicare Part A
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
Medicare Part B
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
POS
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
PPO
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
humana - medicare advantage
Workers Comp
I
22376.55
5642.29
5642.29
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
EPO
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
HMO
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
Medicaid
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
Medicare Part A
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
Medicare Part B
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
POS
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
PPO
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
065
null
ms-drg
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours
tricare
Workers Comp
I
22376.55
5642.29
6998.78
11909.55
13425.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
EPO
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
HMO
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
Medicaid
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
Medicare Part A
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
Medicare Part B
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
POS
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
PPO
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
blue cross blue shield
Workers Comp
I
18385.30
5244.37
7265.54
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
EPO
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
HMO
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
Medicaid
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
Medicare Part A
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
Medicare Part B
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
POS
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
PPO
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
va
Workers Comp
I
18385.30
5244.37
5244.37
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
EPO
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
HMO
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
Medicaid
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
Medicare Part A
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
Medicare Part B
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
POS
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
PPO
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
066
null
ms-drg
intracranial hemorrhage or cerebral infarction without cc/mcc
webtpa
Workers Comp
I
18385.30
5244.37
8433.35
8433.35
11031.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
EPO
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
HMO
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
Medicaid
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
Medicare Part A
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
Medicare Part B
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
POS
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
PPO
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield
Workers Comp
I
18711.37
5189.12
6500.91
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
EPO
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
HMO
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
Medicaid
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
Medicare Part A
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
Medicare Part B
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
POS
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
PPO
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
blue cross blue shield - medicare advantage
Workers Comp
I
18711.37
5189.12
5809.49
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
EPO
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
HMO
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
Medicaid
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
Medicare Part A
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
Medicare Part B
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
POS
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
PPO
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
tricare
Workers Comp
I
18711.37
5189.12
5189.12
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
EPO
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
HMO
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
Medicaid
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
Medicare Part A
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
Medicare Part B
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
POS
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
PPO
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
united healthcare - medicare advantage
Workers Comp
I
18711.37
5189.12
5559.48
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
EPO
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
HMO
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
Medicaid
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
Medicare Part A
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
Medicare Part B
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
POS
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
PPO
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
069
null
ms-drg
transient ischemia without thrombolytic
va
Workers Comp
I
18711.37
5189.12
8131.58
8131.58
11226.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
EPO
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
HMO
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
Medicaid
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
Medicare Part A
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
Medicare Part B
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
POS
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
PPO
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
blue cross blue shield
Workers Comp
I
32218.27
11974.57
18546.75
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
EPO
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
HMO
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
Medicaid
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
Medicare Part A
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
Medicare Part B
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
POS
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
PPO
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
070
null
ms-drg
nonspecific cerebrovascular disorders with mcc
humana - medicare advantage
Workers Comp
I
32218.27
11974.57
11974.57
18546.75
19330.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
EPO
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
HMO
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
Medicaid
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
Medicare Part A
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
Medicare Part B
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
POS
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
PPO
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
humana - medicare advantage
Workers Comp
I
21752.63
3370.61
5305.82
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
EPO
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
HMO
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
Medicaid
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
Medicare Part A
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
Medicare Part B
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
POS
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
PPO
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
tricare
Workers Comp
I
21752.63
3370.61
3370.61
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
EPO
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
HMO
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
Medicaid
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
Medicare Part A
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
Medicare Part B
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
POS
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
PPO
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
071
null
ms-drg
nonspecific cerebrovascular disorders with cc
va
Workers Comp
I
21752.63
3370.61
6683.41
6683.41
13051.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
EPO
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
HMO
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
Medicaid
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
Medicare Part A
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
Medicare Part B
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
POS
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
PPO
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
aetna
Workers Comp
O
3336.94
898.67
1886.64
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
EPO
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
HMO
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
Medicaid
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
Medicare Part A
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
Medicare Part B
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
POS
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
PPO
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield
Workers Comp
O
3336.94
898.67
1017.99
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
EPO
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
HMO
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
Medicaid
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
Medicare Part A
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
Medicare Part B
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
POS
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
PPO
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
blue cross blue shield - medicare advantage
Workers Comp
O
3336.94
898.67
898.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
EPO
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
EPO
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
HMO
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
HMO
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicaid
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicaid
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicare Part A
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicare Part A
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicare Part B
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Medicare Part B
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
POS
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
POS
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
PPO
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
PPO
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Workers Comp
I
1716.45
412.81
818.30
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
cigna
Workers Comp
O
3336.94
898.67
1819.31
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
EPO
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
HMO
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
Medicaid
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
Medicare Part A
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
Medicare Part B
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
POS
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
PPO
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
geha
Workers Comp
O
3336.94
898.67
1861.09
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
EPO
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
HMO
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
Medicaid
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
Medicare Part A
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
Medicare Part B
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
POS
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
PPO
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
healthchoice
Workers Comp
O
3336.94
898.67
2057.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
EPO
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
EPO
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
HMO
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
HMO
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicaid
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicaid
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicare Part A
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicare Part A
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicare Part B
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Medicare Part B
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
POS
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
POS
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
PPO
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
PPO
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Workers Comp
I
1716.45
412.81
3949.45
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
humana - medicare advantage
Workers Comp
O
3336.94
898.67
3367.82
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
EPO
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
HMO
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
Medicaid
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
Medicare Part A
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
Medicare Part B
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
POS
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
PPO
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
tricare
Workers Comp
O
3336.94
898.67
2947.87
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
EPO
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
HMO
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
Medicaid
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
Medicare Part A
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
Medicare Part B
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
POS
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
PPO
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
united healthcare
Workers Comp
O
3336.94
898.67
1609.67
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
EPO
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
EPO
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
HMO
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
HMO
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicaid
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicaid
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicare Part A
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicare Part A
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicare Part B
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Medicare Part B
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
POS
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
POS
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
PPO
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
PPO
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Workers Comp
I
1716.45
412.81
412.81
3949.45
1029.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
va
Workers Comp
O
3336.94
898.67
2942.02
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
EPO
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
HMO
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
Medicaid
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
Medicare Part A
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
Medicare Part B
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
POS
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
PPO
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0710
null
revCode
Recovery Room General
worker comp
Workers Comp
O
3336.94
898.67
2072.13
3367.82
2002.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
EPO
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
HMO
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
Medicaid
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
Medicare Part A
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
Medicare Part B
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
POS
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
PPO
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
072
null
ms-drg
nonspecific cerebrovascular disorders without cc/mcc
blue cross blue shield
Workers Comp
I
18142.44
8552.25
8552.25
8552.25
10885.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
EPO
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
HMO
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
Medicaid
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
Medicare Part A
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
Medicare Part B
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
POS
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
PPO
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
aetna
Workers Comp
I
176.12
35.06
77.64
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
EPO
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
HMO
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
Medicaid
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
Medicare Part A
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
Medicare Part B
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
POS
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
PPO
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield
Workers Comp
O
242.74
163.78
163.78
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
EPO
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
HMO
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
Medicaid
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
Medicare Part A
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
Medicare Part B
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
POS
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
PPO
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
blue cross blue shield - medicare advantage
Workers Comp
O
242.74
163.78
2047.71
2047.71
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
EPO
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
HMO
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
Medicaid
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
Medicare Part A
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
Medicare Part B
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
POS
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
PPO
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
cigna
Workers Comp
I
176.12
35.06
50.79
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
EPO
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
HMO
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
Medicaid
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
Medicare Part A
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
Medicare Part B
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
POS
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
PPO
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
united healthcare
Workers Comp
I
176.12
35.06
3037.96
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
EPO
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
HMO
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
Medicaid
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
Medicare Part A
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
Medicare Part B
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
POS
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
PPO
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
va
Workers Comp
I
176.12
35.06
35.06
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
EPO
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
HMO
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
Medicaid
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
Medicare Part A
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
Medicare Part B
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
POS
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
PPO
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0720
null
revCode
Labor Room/Delivery General
webtpa
Workers Comp
I
176.12
35.06
3332.49
3332.49
105.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
EPO
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
EPO
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
HMO
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
HMO
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicaid
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicaid
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicare Part A
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicare Part A
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicare Part B
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Medicare Part B
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
POS
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
POS
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
PPO
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
PPO
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Workers Comp
I
205.90
68.49
115.70
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna
Workers Comp
O
205.90
39.56
119.42
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
EPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
HMO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
Medicaid
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
Medicare Part A
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
Medicare Part B
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
POS
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
PPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
aetna - medicare advantage
Workers Comp
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
EPO
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
HMO
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
Medicaid
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
Medicare Part A
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
Medicare Part B
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
POS
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
PPO
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield
Workers Comp
O
205.90
39.56
45.41
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
EPO
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
HMO
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
Medicaid
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
Medicare Part A
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
Medicare Part B
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
POS
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
PPO
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
blue cross blue shield - medicare advantage
Workers Comp
O
205.90
39.56
39.56
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
EPO
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
EPO
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
HMO
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
HMO
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicaid
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicaid
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicare Part A
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicare Part A
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicare Part B
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Medicare Part B
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
POS
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
POS
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
PPO
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
PPO
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Workers Comp
I
205.90
68.49
170.90
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
cigna
Workers Comp
O
205.90
39.56
145.70
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
EPO
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
HMO
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
Medicaid
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
Medicare Part A
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
Medicare Part B
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
POS
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
PPO
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
geha
Workers Comp
O
205.90
39.56
147.07
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
EPO
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
HMO
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
Medicaid
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
Medicare Part A
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
Medicare Part B
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
POS
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
PPO
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
healthchoice
Workers Comp
O
205.90
39.56
39.63
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
EPO
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
EPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
HMO
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
HMO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicaid
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicaid
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicare Part A
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicare Part A
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicare Part B
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Medicare Part B
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
POS
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
POS
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
PPO
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
PPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Workers Comp
I
205.90
68.49
201.00
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
humana - medicare advantage
Workers Comp
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
EPO
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
HMO
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
Medicaid
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
Medicare Part A
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
Medicare Part B
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
POS
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
PPO
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
medica
Workers Comp
O
205.90
39.56
76.18
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
EPO
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
HMO
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
Medicaid
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
Medicare Part A
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
Medicare Part B
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
POS
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
PPO
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
tricare
Workers Comp
O
205.90
39.56
48.73
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
EPO
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
EPO
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
HMO
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
HMO
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicaid
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicaid
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicare Part A
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicare Part A
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicare Part B
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Medicare Part B
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
POS
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
POS
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
PPO
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
PPO
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Workers Comp
I
205.90
68.49
147.08
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare
Workers Comp
O
205.90
39.56
147.08
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
EPO
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
HMO
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
Medicaid
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
Medicare Part A
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
Medicare Part B
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
POS
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
PPO
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
united healthcare - medicare advantage
Workers Comp
O
205.90
39.56
47.86
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
EPO
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
EPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
HMO
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
HMO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicaid
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicaid
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicare Part A
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicare Part A
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicare Part B
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Medicare Part B
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
POS
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
POS
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
PPO
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
PPO
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Workers Comp
I
205.90
68.49
68.49
201.00
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
va
Workers Comp
O
205.90
39.56
49.29
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
EPO
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
HMO
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
Medicaid
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
Medicare Part A
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
Medicare Part B
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
POS
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
PPO
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0730
null
revCode
EKG/ECGElectrocardiogram General
webtpa
Workers Comp
O
205.90
39.56
266.11
266.11
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
EPO
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
HMO
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
Medicaid
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
Medicare Part A
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
Medicare Part B
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
POS
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
PPO
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna
Workers Comp
O
237.06
64.70
137.49
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
EPO
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
HMO
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
Medicaid
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
Medicare Part A
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
Medicare Part B
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
POS
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
PPO
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
aetna - medicare advantage
Workers Comp
O
237.06
64.70
95.62
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
EPO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
HMO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
Medicaid
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
Medicare Part A
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
Medicare Part B
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
POS
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
PPO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield
Workers Comp
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
EPO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
HMO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
Medicaid
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
Medicare Part A
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
Medicare Part B
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
POS
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
PPO
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
blue cross blue shield - medicare advantage
Workers Comp
O
237.06
64.70
64.70
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
EPO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
HMO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
Medicaid
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
Medicare Part A
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
Medicare Part B
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
POS
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
PPO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
humana - medicare advantage
Workers Comp
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
EPO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
HMO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
Medicaid
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
Medicare Part A
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
Medicare Part B
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
POS
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
PPO
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
tricare
Workers Comp
O
237.06
64.70
96.59
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
EPO
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
HMO
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
Medicaid
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
Medicare Part A
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
Medicare Part B
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
POS
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
PPO
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
united healthcare
Workers Comp
O
237.06
64.70
173.57
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
EPO
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
HMO
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
Medicaid
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
Medicare Part A
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
Medicare Part B
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
POS
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
PPO
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
va
Workers Comp
O
237.06
64.70
96.61
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
EPO
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
HMO
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
Medicaid
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
Medicare Part A
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
Medicare Part B
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
POS
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
PPO
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0731
null
revCode
EKG/ECGElectrocardiogram Holter monitor
webtpa
Workers Comp
O
237.06
64.70
323.99
323.99
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
EPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
HMO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
Medicaid
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
Medicare Part A
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
Medicare Part B
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
POS
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
PPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield
Workers Comp
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
EPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
HMO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
Medicaid
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
Medicare Part A
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
Medicare Part B
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
POS
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
PPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
blue cross blue shield - medicare advantage
Workers Comp
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
EPO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
HMO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
Medicaid
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
Medicare Part A
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
Medicare Part B
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
POS
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
PPO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
humana - medicare advantage
Workers Comp
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
EPO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
HMO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
Medicaid
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
Medicare Part A
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
Medicare Part B
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
POS
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
PPO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
united healthcare
Workers Comp
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
EPO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
HMO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
Medicaid
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
Medicare Part A
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
Medicare Part B
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
POS
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
PPO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0732
null
revCode
EKG/ECGElectrocardiogram Telemetry
webtpa
Workers Comp
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
EPO
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
HMO
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
Medicaid
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
Medicare Part A
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
Medicare Part B
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
POS
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
PPO
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
aetna
Workers Comp
I
18506.51
6023.27
6023.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
EPO
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
HMO
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
Medicaid
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
POS
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
PPO
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
18506.51
6023.27
7120.15
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
EPO
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
HMO
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
Medicaid
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
Medicare Part A
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
Medicare Part B
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
POS
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
PPO
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
humana - medicare advantage
Workers Comp
I
18506.51
6023.27
6617.27
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
EPO
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
HMO
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
Medicaid
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
Medicare Part A
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
Medicare Part B
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
POS
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
PPO
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
074
null
ms-drg
cranial and peripheral nerve disorders without mcc
va
Workers Comp
I
18506.51
6023.27
7385.42
7385.42
11103.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
EPO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
HMO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
Medicaid
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
Medicare Part A
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
Medicare Part B
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
POS
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
PPO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield
Workers Comp
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
EPO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
HMO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
Medicaid
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
Medicare Part A
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
Medicare Part B
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
POS
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
PPO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
blue cross blue shield - medicare advantage
Workers Comp
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
EPO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
HMO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
Medicaid
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
Medicare Part A
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
Medicare Part B
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
POS
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
PPO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
healthchoice
Workers Comp
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
EPO
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
EPO
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
HMO
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
HMO
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicaid
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicaid
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicare Part A
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicare Part A
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicare Part B
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Medicare Part B
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
POS
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
POS
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
PPO
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
PPO
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Workers Comp
I
702.30
136.57
240.00
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
humana - medicare advantage
Workers Comp
O
508.64
197.17
229.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
EPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
HMO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
Medicaid
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
Medicare Part A
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
Medicare Part B
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
POS
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
PPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
tricare
Workers Comp
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
EPO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
HMO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
Medicaid
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
Medicare Part A
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
Medicare Part B
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
POS
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
PPO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
united healthcare
Workers Comp
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
EPO
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
HMO
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
Medicaid
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
Medicare Part A
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
Medicare Part B
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
POS
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
PPO
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
va
Workers Comp
I
702.30
136.57
136.57
240.00
421.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
EPO
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
HMO
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
Medicaid
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
Medicare Part A
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
Medicare Part B
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
POS
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
PPO
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0740
null
revCode
EEG Electroencephalogram General
webtpa
Workers Comp
O
508.64
197.17
490.46
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
EPO
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
HMO
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
Medicaid
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
Medicare Part A
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
Medicare Part B
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
POS
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
PPO
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
075
null
ms-drg
viral meningitis with cc/mcc
va
Workers Comp
I
42851.03
10265.24
10265.24
10265.24
25710.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
EPO
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
HMO
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
Medicaid
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
Medicare Part A
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
Medicare Part B
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
POS
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
PPO
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna
Workers Comp
O
2203.74
285.34
1300.21
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
EPO
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
HMO
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
Medicaid
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
Medicare Part A
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
Medicare Part B
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
POS
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
PPO
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
aetna - medicare advantage
Workers Comp
O
2203.74
285.34
772.95
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
EPO
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
HMO
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
Medicaid
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
Medicare Part A
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
Medicare Part B
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
POS
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
PPO
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield
Workers Comp
O
2203.74
285.34
890.41
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
EPO
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
HMO
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
Medicaid
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
Medicare Part A
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
Medicare Part B
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
POS
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
PPO
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
blue cross blue shield - medicare advantage
Workers Comp
O
2203.74
285.34
870.56
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
EPO
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
HMO
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
Medicaid
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
Medicare Part A
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
Medicare Part B
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
POS
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
PPO
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
cigna
Workers Comp
O
2203.74
285.34
1207.11
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
EPO
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
HMO
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
Medicaid
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
Medicare Part A
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
Medicare Part B
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
POS
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
PPO
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
geha
Workers Comp
O
2203.74
285.34
896.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
EPO
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
HMO
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
Medicaid
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
Medicare Part A
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
Medicare Part B
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
POS
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
PPO
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
healthchoice
Workers Comp
O
2203.74
285.34
285.34
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
EPO
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
HMO
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
Medicaid
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
Medicare Part A
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
Medicare Part B
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
POS
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
PPO
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
humana - medicare advantage
Workers Comp
O
2203.74
285.34
702.89
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
EPO
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
HMO
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
Medicaid
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
Medicare Part A
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
Medicare Part B
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
POS
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
PPO
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
medica
Workers Comp
O
2203.74
285.34
928.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
EPO
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
HMO
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
Medicaid
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
Medicare Part A
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
Medicare Part B
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
POS
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
PPO
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
tricare
Workers Comp
O
2203.74
285.34
696.23
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
EPO
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
HMO
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
Medicaid
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
Medicare Part A
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
Medicare Part B
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
POS
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
PPO
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare
Workers Comp
O
2203.74
285.34
1119.36
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
EPO
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
HMO
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
Medicaid
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
Medicare Part A
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
Medicare Part B
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
POS
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
PPO
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
united healthcare - medicare advantage
Workers Comp
O
2203.74
285.34
873.61
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
EPO
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
EPO
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
HMO
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
HMO
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicaid
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicaid
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicare Part A
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicare Part A
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicare Part B
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Medicare Part B
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
POS
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
POS
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
PPO
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
PPO
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Workers Comp
I
345.25
81.60
81.60
81.60
207.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
va
Workers Comp
O
2203.74
285.34
716.99
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
EPO
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
HMO
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
Medicaid
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
Medicare Part A
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
Medicare Part B
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
POS
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
PPO
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0750
null
revCode
Gastrointestinal Services General
webtpa
Workers Comp
O
2203.74
285.34
2501.50
2501.50
1322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
EPO
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
HMO
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
Medicaid
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
Medicare Part A
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
Medicare Part B
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
POS
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
PPO
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
076
null
ms-drg
viral meningitis without cc/mcc
tricare
Workers Comp
I
22341.47
2901.98
2901.98
2901.98
13404.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
EPO
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
EPO
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
HMO
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
HMO
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicaid
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicaid
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicare Part A
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicare Part A
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicare Part B
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Medicare Part B
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
POS
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
POS
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
PPO
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
PPO
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Workers Comp
I
136.89
35.11
122.24
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna
Workers Comp
O
596.67
10.55
143.22
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
EPO
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
HMO
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
Medicaid
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
Medicare Part A
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
Medicare Part B
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
POS
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
PPO
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
aetna - medicare advantage
Workers Comp
O
596.67
10.55
283.05
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
EPO
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
HMO
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
Medicaid
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
Medicare Part A
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
Medicare Part B
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
POS
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
PPO
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield
Workers Comp
O
596.67
10.55
39.82
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
EPO
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
HMO
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
Medicaid
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
Medicare Part A
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
Medicare Part B
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
POS
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
PPO
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
blue cross blue shield - medicare advantage
Workers Comp
O
596.67
10.55
56.84
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
EPO
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
HMO
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
Medicaid
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
Medicare Part A
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
Medicare Part B
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
POS
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
PPO
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
cigna
Workers Comp
O
596.67
10.55
629.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
EPO
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
HMO
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
Medicaid
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
Medicare Part A
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
Medicare Part B
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
POS
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
PPO
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
geha
Workers Comp
O
596.67
10.55
182.06
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
EPO
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
HMO
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
Medicaid
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
Medicare Part A
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
Medicare Part B
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
POS
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
PPO
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
healthchoice
Workers Comp
O
596.67
10.55
10.55
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
EPO
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
HMO
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
Medicaid
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
Medicare Part A
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
Medicare Part B
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
POS
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
PPO
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
humana - medicare advantage
Workers Comp
O
596.67
10.55
306.29
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
EPO
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
HMO
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
Medicaid
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
Medicare Part A
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
Medicare Part B
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
POS
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
PPO
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
tricare
Workers Comp
O
596.67
10.55
105.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
EPO
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
EPO
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
HMO
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
HMO
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicaid
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicaid
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicare Part A
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicare Part A
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicare Part B
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Medicare Part B
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
POS
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
POS
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
PPO
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
PPO
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Workers Comp
I
136.89
35.11
230.07
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare
Workers Comp
O
596.67
10.55
121.40
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
EPO
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
HMO
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
Medicaid
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
Medicare Part A
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
Medicare Part B
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
POS
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
PPO
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
united healthcare - medicare advantage
Workers Comp
O
596.67
10.55
265.44
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
EPO
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
EPO
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
HMO
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
HMO
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicaid
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicaid
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicare Part A
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicare Part A
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicare Part B
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Medicare Part B
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
POS
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
POS
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
PPO
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
PPO
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Workers Comp
I
136.89
35.11
35.11
230.07
82.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
va
Workers Comp
O
596.67
10.55
306.28
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
EPO
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
HMO
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
Medicaid
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
Medicare Part A
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
Medicare Part B
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
POS
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
PPO
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
webtpa
Workers Comp
O
596.67
10.55
695.16
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
EPO
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
HMO
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
Medicaid
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
Medicare Part A
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
Medicare Part B
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
POS
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
PPO
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0761
null
revCode
Specialty Services Treatment room
worker comp
Workers Comp
O
596.67
10.55
365.25
695.16
358.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
EPO
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
HMO
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
Medicaid
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
Medicare Part A
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
Medicare Part B
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
POS
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
PPO
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
aetna
Workers Comp
I
21.42
5.36
59.08
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
EPO
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
HMO
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
Medicaid
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
Medicare Part A
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
Medicare Part B
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
POS
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
PPO
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield
Workers Comp
O
441.56
11.77
75.89
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
EPO
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
HMO
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
Medicaid
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
Medicare Part A
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
Medicare Part B
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
POS
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
PPO
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
blue cross blue shield - medicare advantage
Workers Comp
O
441.56
11.77
156.31
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
EPO
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
HMO
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
Medicaid
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
Medicare Part A
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
Medicare Part B
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
POS
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
PPO
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
united healthcare
Workers Comp
O
441.56
11.77
11.77
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
EPO
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
HMO
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
Medicaid
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
Medicare Part A
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
Medicare Part B
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
POS
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
PPO
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
va
Workers Comp
I
21.42
5.36
5.36
59.08
12.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
EPO
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
HMO
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
Medicaid
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
Medicare Part A
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
Medicare Part B
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
POS
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
PPO
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0762
null
revCode
Specialty Services Observation hours
webtpa
Workers Comp
O
441.56
11.77
4875.69
4875.69
264.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
EPO
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
HMO
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
Medicaid
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
Medicare Part A
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
Medicare Part B
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
POS
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
PPO
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0770
null
revCode
Preventive Services General
tricare
Workers Comp
O
278.78
24.64
24.64
24.64
167.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
EPO
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
EPO
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
HMO
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
HMO
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicaid
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicaid
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicare Part A
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicare Part A
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicare Part B
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Medicare Part B
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
POS
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
POS
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
PPO
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
PPO
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Workers Comp
I
24.47
8.55
14.44
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna
Workers Comp
O
99.09
34.60
448.92
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
EPO
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
HMO
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
Medicaid
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
Medicare Part A
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
Medicare Part B
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
POS
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
PPO
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
aetna - medicare advantage
Workers Comp
O
99.09
34.60
35.43
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
EPO
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
HMO
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
Medicaid
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
Medicare Part A
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
Medicare Part B
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
POS
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
PPO
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield
Workers Comp
O
99.09
34.60
151.57
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
EPO
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
HMO
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
Medicaid
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
Medicare Part A
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
Medicare Part B
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
POS
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
PPO
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
blue cross blue shield - medicare advantage
Workers Comp
O
99.09
34.60
130.10
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
EPO
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
HMO
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
Medicaid
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
Medicare Part A
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
Medicare Part B
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
POS
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
PPO
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
humana - medicare advantage
Workers Comp
O
99.09
34.60
34.60
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
EPO
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
HMO
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
Medicaid
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
Medicare Part A
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
Medicare Part B
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
POS
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
PPO
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
tricare
Workers Comp
O
99.09
34.60
398.98
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
EPO
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
EPO
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
HMO
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
HMO
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicaid
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicaid
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicare Part A
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicare Part A
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicare Part B
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Medicare Part B
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
POS
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
POS
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
PPO
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
PPO
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Workers Comp
I
24.47
8.55
8.55
14.44
14.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0771
null
revCode
Preventive Services Vaccine administration
va
Workers Comp
O
99.09
34.60
398.97
448.92
59.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
EPO
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
HMO
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
Medicaid
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
Medicare Part A
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
Medicare Part B
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
POS
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
PPO
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0801
null
revCode
Inpatient Renal Dialysis Inpatient hemodialysis
va
Workers Comp
I
1806.70
684.29
684.29
684.29
1084.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
EPO
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
HMO
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
Medicaid
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
Medicare Part A
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
Medicare Part B
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
POS
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
PPO
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
081
null
ms-drg
nontraumatic stupor and coma without mcc
humana - medicare advantage
Workers Comp
I
19922.13
4339.20
4339.20
4339.20
11953.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
EPO
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
HMO
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
Medicaid
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
Medicare Part A
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
Medicare Part B
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
POS
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
PPO
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
humana - medicare advantage
Workers Comp
I
49275.51
11831.40
11831.40
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
EPO
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
HMO
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
Medicaid
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
Medicare Part A
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
Medicare Part B
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
POS
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
PPO
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
082
null
ms-drg
traumatic stupor and coma >1 hour with mcc
va
Workers Comp
I
49275.51
11831.40
15130.32
15130.32
29565.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
EPO
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
HMO
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
Medicaid
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
Medicare Part A
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
Medicare Part B
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
POS
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
PPO
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
086
null
ms-drg
traumatic stupor and coma <1 hour with cc
humana - medicare advantage
Workers Comp
I
30270.55
8293.31
8293.31
8293.31
18162.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
EPO
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
HMO
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
Medicaid
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
Medicare Part A
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
Medicare Part B
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
POS
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
PPO
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
087
null
ms-drg
traumatic stupor and coma <1 hour without cc/mcc
va
Workers Comp
I
21548.26
5785.31
5785.31
5785.31
12928.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
EPO
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
HMO
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
Medicaid
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
Medicare Part A
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
Medicare Part B
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
POS
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
PPO
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
091
null
ms-drg
other disorders of nervous system with mcc
humana - medicare advantage
Workers Comp
I
45981.95
11083.88
11083.88
11083.88
27589.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
EPO
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
HMO
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
Medicaid
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
Medicare Part A
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
Medicare Part B
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
POS
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
PPO
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
092
null
ms-drg
other disorders of nervous system with cc
va
Workers Comp
I
19149.35
6742.15
6742.15
6742.15
11489.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
EPO
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
HMO
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
Medicaid
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
Medicare Part A
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
Medicare Part B
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
POS
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
PPO
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna
Workers Comp
O
1437.36
13.58
637.11
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
EPO
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
HMO
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
Medicaid
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
Medicare Part A
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
Medicare Part B
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
POS
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
PPO
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
aetna - medicare advantage
Workers Comp
O
1437.36
13.58
97.40
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
EPO
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
HMO
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
Medicaid
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
Medicare Part A
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
Medicare Part B
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
POS
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
PPO
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield
Workers Comp
O
1437.36
13.58
359.62
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
EPO
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
HMO
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
Medicaid
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
Medicare Part A
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
Medicare Part B
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
POS
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
PPO
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
blue cross blue shield - medicare advantage
Workers Comp
O
1437.36
13.58
199.81
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
EPO
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
HMO
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
Medicaid
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
Medicare Part A
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
Medicare Part B
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
POS
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
PPO
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
cigna
Workers Comp
O
1437.36
13.58
166.97
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
EPO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
HMO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
Medicaid
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
Medicare Part A
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
Medicare Part B
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
POS
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
PPO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
geha
Workers Comp
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
EPO
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
HMO
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
Medicaid
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
Medicare Part A
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
Medicare Part B
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
POS
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
PPO
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
healthchoice
Workers Comp
O
1437.36
13.58
13.58
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
EPO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
HMO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
Medicaid
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
Medicare Part A
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
Medicare Part B
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
POS
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
PPO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
humana - medicare advantage
Workers Comp
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
EPO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
HMO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
Medicaid
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
Medicare Part A
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
Medicare Part B
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
POS
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
PPO
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
tricare
Workers Comp
O
1437.36
13.58
805.22
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
EPO
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
HMO
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
Medicaid
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
Medicare Part A
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
Medicare Part B
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
POS
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
PPO
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
united healthcare
Workers Comp
O
1437.36
13.58
176.96
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
EPO
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
HMO
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
Medicaid
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
Medicare Part A
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
Medicare Part B
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
POS
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
PPO
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
va
Workers Comp
O
1437.36
13.58
814.60
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
EPO
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
HMO
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
Medicaid
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
Medicare Part A
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
Medicare Part B
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
POS
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
PPO
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
webtpa
Workers Comp
O
1437.36
13.58
2756.00
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
EPO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
HMO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
Medicaid
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
Medicare Part A
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
Medicare Part B
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
POS
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
PPO
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0920
null
revCode
Other Diagnostic Services General
worker comp
Workers Comp
O
1437.36
13.58
1078.02
2756.00
862.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
EPO
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
EPO
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
HMO
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
HMO
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicaid
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicaid
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicare Part A
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicare Part A
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicare Part B
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Medicare Part B
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
POS
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
POS
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
PPO
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
PPO
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Workers Comp
I
685.60
114.65
114.65
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna
Workers Comp
O
671.13
203.81
387.26
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
aetna - medicare advantage
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
EPO
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
HMO
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
Medicaid
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
Medicare Part A
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
Medicare Part B
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
POS
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
PPO
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield
Workers Comp
O
671.13
203.81
286.66
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
EPO
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
HMO
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
Medicaid
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
Medicare Part A
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
Medicare Part B
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
POS
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
PPO
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
blue cross blue shield - medicare advantage
Workers Comp
O
671.13
203.81
359.62
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
EPO
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
HMO
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
Medicaid
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
Medicare Part A
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
Medicare Part B
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
POS
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
PPO
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
cigna
Workers Comp
O
671.13
203.81
283.11
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
EPO
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
HMO
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
Medicaid
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
Medicare Part A
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
Medicare Part B
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
POS
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
PPO
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
geha
Workers Comp
O
671.13
203.81
411.02
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
EPO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
HMO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
Medicaid
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
Medicare Part A
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
Medicare Part B
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
POS
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
PPO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
healthchoice
Workers Comp
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
humana - medicare advantage
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
EPO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
HMO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
Medicaid
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
Medicare Part A
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
Medicare Part B
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
POS
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
PPO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
medica
Workers Comp
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
tricare
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
EPO
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
EPO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
HMO
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
HMO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicaid
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicaid
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicare Part A
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicare Part A
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicare Part B
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Medicare Part B
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
POS
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
POS
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
PPO
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
PPO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Workers Comp
I
685.60
114.65
484.58
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare
Workers Comp
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
EPO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
HMO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
Medicaid
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
Medicare Part A
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
Medicare Part B
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
POS
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
PPO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
united healthcare - medicare advantage
Workers Comp
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
EPO
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
HMO
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicaid
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicare Part A
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicare Part B
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
POS
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
PPO
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Workers Comp
I
685.60
114.65
222.12
484.58
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
va
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
EPO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
HMO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
Medicaid
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
Medicare Part A
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
Medicare Part B
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
POS
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
PPO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0921
null
revCode
Other Diagnostic Services Peripheral vascular lab
webtpa
Workers Comp
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
POS
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
22670.03
4952.67
6136.72
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
EPO
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
HMO
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
Medicaid
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
Medicare Part A
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
Medicare Part B
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
POS
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
PPO
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
093
null
ms-drg
other disorders of nervous system without cc/mcc
tricare
Workers Comp
I
22670.03
4952.67
4952.67
6136.72
13602.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
EPO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
HMO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
Medicaid
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
Medicare Part A
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
Medicare Part B
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
POS
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
PPO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
blue cross blue shield
Workers Comp
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
EPO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
HMO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
Medicaid
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
Medicare Part A
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
Medicare Part B
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
POS
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
PPO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0940
null
revCode
Medical Rehabilitation Day Program General
humana - medicare advantage
Workers Comp
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
EPO
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
HMO
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
Medicaid
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
Medicare Part A
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
Medicare Part B
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
POS
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
PPO
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
aetna
Workers Comp
O
155.82
24.64
90.38
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
EPO
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
HMO
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
Medicaid
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
Medicare Part A
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
Medicare Part B
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
POS
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
PPO
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield
Workers Comp
O
155.82
24.64
99.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
EPO
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
HMO
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
Medicaid
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
Medicare Part A
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
Medicare Part B
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
POS
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
PPO
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
blue cross blue shield - medicare advantage
Workers Comp
O
155.82
24.64
155.82
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
EPO
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
HMO
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
Medicaid
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
Medicare Part A
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
Medicare Part B
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
POS
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
PPO
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
tricare
Workers Comp
O
155.82
24.64
24.64
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
EPO
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
HMO
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
Medicaid
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
Medicare Part A
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
Medicare Part B
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
POS
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
PPO
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
united healthcare
Workers Comp
O
155.82
24.64
111.30
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
EPO
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
HMO
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
Medicaid
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
Medicare Part A
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
Medicare Part B
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
POS
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
PPO
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0942
null
revCode
Medical Rehabilitation Day Program Education/training
webtpa
Workers Comp
O
155.82
24.64
109.07
155.82
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
EPO
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
HMO
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
Medicaid
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
Medicare Part A
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
Medicare Part B
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
POS
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
PPO
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna
Workers Comp
O
164.05
41.29
92.18
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
EPO
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
HMO
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
Medicaid
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
Medicare Part A
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
Medicare Part B
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
POS
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
PPO
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
aetna - medicare advantage
Workers Comp
O
164.05
41.29
102.79
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
EPO
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
HMO
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
Medicaid
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
Medicare Part A
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
Medicare Part B
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
POS
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
PPO
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield
Workers Comp
O
164.05
41.29
123.04
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
EPO
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
HMO
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
Medicaid
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
Medicare Part A
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
Medicare Part B
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
POS
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
PPO
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
blue cross blue shield - medicare advantage
Workers Comp
O
164.05
41.29
106.19
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
EPO
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
HMO
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
Medicaid
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
Medicare Part A
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
Medicare Part B
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
POS
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
PPO
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
cigna
Workers Comp
O
164.05
41.29
116.09
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
EPO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
HMO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
Medicaid
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
Medicare Part A
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
Medicare Part B
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
POS
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
PPO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
humana - medicare advantage
Workers Comp
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
EPO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
HMO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
Medicaid
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
Medicare Part A
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
Medicare Part B
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
POS
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
PPO
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
tricare
Workers Comp
O
164.05
41.29
97.47
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
EPO
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
HMO
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
Medicaid
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
Medicare Part A
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
Medicare Part B
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
POS
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
PPO
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
va
Workers Comp
O
164.05
41.29
102.78
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
EPO
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
HMO
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
Medicaid
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
Medicare Part A
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
Medicare Part B
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
POS
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
PPO
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0943
null
revCode
Medical Rehabilitation Day Program Cardiac rehabilitation
webtpa
Workers Comp
O
164.05
41.29
41.29
123.04
98.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
EPO
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
HMO
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
Medicaid
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
Medicare Part A
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
Medicare Part B
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
POS
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
PPO
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
aetna
Workers Comp
I
140.23
47.79
421.52
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
EPO
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
HMO
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
Medicaid
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
Medicare Part A
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
Medicare Part B
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
POS
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
PPO
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0946
null
revCode
Medical Rehabilitation Day Program Complex medical equipment - routine
va
Workers Comp
I
140.23
47.79
47.79
421.52
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
EPO
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
HMO
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
Medicaid
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
Medicare Part A
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
Medicare Part B
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
POS
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
PPO
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
095
null
ms-drg
bacterial and tuberculous infections of nervous system with cc
blue cross blue shield
Workers Comp
I
89826.53
19312.05
19312.05
19312.05
53895.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
EPO
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
HMO
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
Medicaid
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
Medicare Part A
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
Medicare Part B
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
POS
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
PPO
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
097
null
ms-drg
non-bacterial infection of nervous system except viral meningitis with mcc
humana - medicare advantage
Workers Comp
I
122851.19
22806.74
22806.74
22806.74
73710.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
EPO
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
HMO
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
Medicaid
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
Medicare Part A
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
Medicare Part B
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
POS
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
PPO
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
099
null
ms-drg
non-bacterial infection of nervous system except viral meningitis without cc/mcc
tricare
Workers Comp
I
37038.34
8377.51
8377.51
8377.51
22223.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
EPO
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
HMO
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
Medicaid
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
Medicare Part A
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
Medicare Part B
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
POS
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
PPO
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
blue cross blue shield
Workers Comp
I
27940.37
9844.84
18537.75
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
EPO
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
HMO
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
Medicaid
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
Medicare Part A
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
Medicare Part B
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
POS
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
PPO
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
100
null
ms-drg
seizures with mcc
humana - medicare advantage
Workers Comp
I
27940.37
9844.84
9844.84
18537.75
16764.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
EPO
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
HMO
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
Medicaid
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
Medicare Part A
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
Medicare Part B
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
POS
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
PPO
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
aetna
Workers Comp
O
2365.99
535.49
1156.19
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
EPO
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
HMO
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
Medicaid
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
Medicare Part A
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
Medicare Part B
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
POS
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
PPO
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield
Workers Comp
O
2365.99
535.49
1466.44
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
EPO
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
HMO
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
Medicaid
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
POS
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
PPO
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
blue cross blue shield - medicare advantage
Workers Comp
O
2365.99
535.49
1237.97
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
EPO
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
HMO
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
Medicaid
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
Medicare Part A
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
Medicare Part B
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
POS
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
PPO
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
humana - medicare advantage
Workers Comp
O
2365.99
535.49
535.49
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
EPO
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
HMO
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
Medicaid
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
Medicare Part A
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
Medicare Part B
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
POS
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
PPO
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
tricare
Workers Comp
O
2365.99
535.49
550.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
EPO
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
HMO
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
Medicaid
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
Medicare Part A
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
Medicare Part B
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
POS
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
PPO
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
united healthcare
Workers Comp
O
2365.99
535.49
1833.84
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
EPO
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
HMO
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
Medicaid
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
Medicare Part A
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
Medicare Part B
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
POS
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
PPO
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10005
null
cpt
Fine needle aspiration of first lesion using ultrasound guidance
va
Workers Comp
O
2365.99
535.49
1367.16
1833.84
1419.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
EPO
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
HMO
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
Medicaid
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
Medicare Part A
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
Medicare Part B
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
POS
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
PPO
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10006
null
cpt
Fine needle aspiration of additional lesion using ultrasound guidance
blue cross blue shield
Workers Comp
O
4307.28
1567.18
1567.18
1567.18
2584.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
EPO
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
HMO
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
Medicaid
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
Medicare Part A
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
Medicare Part B
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
POS
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
PPO
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10009
null
cpt
Fine needle aspiration of first lesion using CT guidance
united healthcare
Workers Comp
O
6986.21
5239.66
5239.66
5239.66
4191.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
EPO
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
HMO
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
Medicaid
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
Medicare Part A
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
Medicare Part B
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
POS
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
PPO
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
blue cross blue shield
Workers Comp
I
21944.75
4709.98
6886.91
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
EPO
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
HMO
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
Medicaid
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
Medicare Part A
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
Medicare Part B
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
POS
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
PPO
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
101
null
ms-drg
seizures without mcc
tricare
Workers Comp
I
21944.75
4709.98
4709.98
6886.91
13166.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
EPO
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
HMO
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
Medicaid
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
Medicare Part A
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
Medicare Part B
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
POS
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
PPO
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield
Workers Comp
O
15509.90
334.36
832.30
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
EPO
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
HMO
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
Medicaid
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
Medicare Part A
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
Medicare Part B
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
POS
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
PPO
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
blue cross blue shield - medicare advantage
Workers Comp
O
15509.90
334.36
698.96
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
EPO
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
HMO
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
Medicaid
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
Medicare Part A
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
Medicare Part B
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
POS
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
PPO
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10120
null
cpt
Removal of foreign body from tissue accessed beneath the skin simple
humana - medicare advantage
Workers Comp
O
15509.90
334.36
334.36
832.30
9305.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
EPO
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
HMO
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
Medicaid
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
Medicare Part A
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
Medicare Part B
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
POS
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
PPO
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
blue cross blue shield - medicare advantage
Workers Comp
O
17560.92
2796.62
5905.66
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
EPO
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
HMO
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
Medicaid
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
Medicare Part A
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
Medicare Part B
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
POS
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
PPO
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10140
null
cpt
Drainage of blood or fluid accumulation
humana - medicare advantage
Workers Comp
O
17560.92
2796.62
2796.62
5905.66
10536.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
EPO
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
HMO
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
Medicaid
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
Medicare Part A
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
Medicare Part B
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
POS
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
PPO
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
10180
null
cpt
Drainage of wound infection after surgery
blue cross blue shield - medicare advantage
Workers Comp
O
15202.20
1186.50
1186.50
1186.50
9121.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
EPO
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
HMO
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
Medicaid
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
Medicare Part A
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
Medicare Part B
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
POS
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
PPO
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
103
null
ms-drg
headaches without mcc
tricare
Workers Comp
I
16271.54
4381.26
4381.26
4381.26
9762.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
EPO
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
HMO
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
Medicaid
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
Medicare Part A
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
Medicare Part B
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
POS
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
PPO
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11012
null
cpt
Removal of foreign material from skin tissue muscle and bone at open fracture and/or dislocation
tricare
Workers Comp
O
20937.23
2054.26
2054.26
2054.26
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
EPO
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
HMO
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
Medicaid
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
Medicare Part A
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
Medicare Part B
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
POS
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
PPO
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna
Workers Comp
O
1234.07
112.65
112.65
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
EPO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
HMO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
Medicaid
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
Medicare Part A
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
Medicare Part B
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
POS
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
PPO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
aetna - medicare advantage
Workers Comp
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
EPO
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
HMO
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
Medicaid
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
Medicare Part A
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
Medicare Part B
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
POS
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
PPO
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield
Workers Comp
O
1234.07
112.65
631.95
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
EPO
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
HMO
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicaid
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicare Part A
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicare Part B
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
POS
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
PPO
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
blue cross blue shield - medicare advantage
Workers Comp
O
1234.07
112.65
616.41
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
EPO
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
HMO
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
Medicaid
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
Medicare Part A
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
Medicare Part B
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
POS
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
PPO
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
cigna
Workers Comp
O
1234.07
112.65
675.67
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
EPO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
HMO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
Medicaid
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
Medicare Part A
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
Medicare Part B
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
POS
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
PPO
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
humana - medicare advantage
Workers Comp
O
1234.07
112.65
306.29
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
EPO
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
HMO
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
Medicaid
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
Medicare Part A
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
Medicare Part B
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
POS
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
PPO
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
tricare
Workers Comp
O
1234.07
112.65
283.05
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
EPO
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
HMO
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
Medicaid
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
Medicare Part A
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
Medicare Part B
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
POS
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
PPO
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare
Workers Comp
O
1234.07
112.65
1392.99
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
EPO
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
HMO
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
Medicaid
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
Medicare Part A
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
Medicare Part B
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
POS
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
PPO
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
united healthcare - medicare advantage
Workers Comp
O
1234.07
112.65
277.79
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
EPO
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
HMO
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
Medicaid
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
Medicare Part A
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
Medicare Part B
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
POS
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
PPO
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11042
null
cpt
Removal of skin and tissue first 20 sq cm or less
va
Workers Comp
O
1234.07
112.65
306.28
1392.99
740.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
EPO
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
HMO
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
Medicaid
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
Medicare Part A
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
Medicare Part B
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
POS
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
PPO
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
blue cross blue shield
Workers Comp
O
2120.86
440.30
1134.06
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
EPO
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
HMO
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
Medicaid
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
Medicare Part A
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
Medicare Part B
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
POS
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
PPO
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
humana - medicare advantage
Workers Comp
O
2120.86
440.30
440.30
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
EPO
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
HMO
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
Medicaid
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
Medicare Part A
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
Medicare Part B
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
POS
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
PPO
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
tricare
Workers Comp
O
2120.86
440.30
593.38
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
EPO
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
HMO
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
Medicaid
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
Medicare Part A
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
Medicare Part B
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
POS
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
PPO
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
united healthcare - medicare advantage
Workers Comp
O
2120.86
440.30
570.60
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
EPO
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
HMO
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
Medicaid
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
Medicare Part A
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
Medicare Part B
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
POS
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
PPO
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11043
null
cpt
Removal of skin and/or muscle first 20 sq cm or less
va
Workers Comp
O
2120.86
440.30
464.21
1134.06
1272.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
EPO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
HMO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
Medicaid
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
Medicare Part A
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
Medicare Part B
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
POS
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
PPO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
aetna - medicare advantage
Workers Comp
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
EPO
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
HMO
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicaid
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicare Part A
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
Medicare Part B
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
POS
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
PPO
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
blue cross blue shield - medicare advantage
Workers Comp
O
3902.19
1215.96
1958.85
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
EPO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
HMO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
Medicaid
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
Medicare Part A
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
Medicare Part B
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
POS
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
PPO
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
humana - medicare advantage
Workers Comp
O
3902.19
1215.96
1246.10
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
EPO
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
HMO
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
Medicaid
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
Medicare Part A
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
Medicare Part B
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
POS
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
PPO
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
tricare
Workers Comp
O
3902.19
1215.96
1215.96
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
EPO
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
HMO
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
Medicaid
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
Medicare Part A
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
Medicare Part B
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
POS
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
PPO
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11044
null
cpt
Removal of skin and bone first 20 sq cm or less
va
Workers Comp
O
3902.19
1215.96
3824.63
3824.63
2341.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
EPO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
HMO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
Medicaid
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
Medicare Part A
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
Medicare Part B
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
POS
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
PPO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
aetna - medicare advantage
Workers Comp
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
EPO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
HMO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
Medicaid
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
Medicare Part A
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
Medicare Part B
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
POS
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
PPO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield
Workers Comp
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
EPO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
HMO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
Medicaid
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
Medicare Part A
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
Medicare Part B
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
POS
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
PPO
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
blue cross blue shield - medicare advantage
Workers Comp
O
2789.17
283.05
725.19
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
EPO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
HMO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
Medicaid
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
Medicare Part A
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
Medicare Part B
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
POS
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
PPO
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
humana - medicare advantage
Workers Comp
O
2789.17
283.05
306.29
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
EPO
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
HMO
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
Medicaid
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
Medicare Part A
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
Medicare Part B
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
POS
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
PPO
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
tricare
Workers Comp
O
2789.17
283.05
283.05
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
EPO
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
HMO
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
Medicaid
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
Medicare Part A
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
Medicare Part B
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
POS
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
PPO
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare
Workers Comp
O
2789.17
283.05
3444.67
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
EPO
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
HMO
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
Medicaid
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
Medicare Part A
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
Medicare Part B
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
POS
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
PPO
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
united healthcare - medicare advantage
Workers Comp
O
2789.17
283.05
496.07
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
EPO
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
HMO
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
Medicaid
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
Medicare Part A
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
Medicare Part B
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
POS
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
PPO
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11045
null
cpt
Removal of skin and tissue
va
Workers Comp
O
2789.17
283.05
306.28
3444.67
1673.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
EPO
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
HMO
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
Medicaid
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
Medicare Part A
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
Medicare Part B
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
POS
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
PPO
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
blue cross blue shield
Workers Comp
O
2795.24
371.38
1134.06
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
EPO
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
HMO
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
Medicaid
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
Medicare Part A
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
Medicare Part B
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
POS
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
PPO
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
humana - medicare advantage
Workers Comp
O
2795.24
371.38
371.38
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
EPO
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
HMO
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
Medicaid
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
Medicare Part A
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
Medicare Part B
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
POS
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
PPO
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11046
null
cpt
Removal of skin and/or muscle
va
Workers Comp
O
2795.24
371.38
464.21
1134.06
1677.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
EPO
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
HMO
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
Medicaid
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
Medicare Part A
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
Medicare Part B
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
POS
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
PPO
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11047
null
cpt
Removal of skin and bone
aetna - medicare advantage
Workers Comp
O
10087.87
1215.96
1215.96
1215.96
6052.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
EPO
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
HMO
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
Medicaid
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
Medicare Part A
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
Medicare Part B
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
POS
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
PPO
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
blue cross blue shield
Workers Comp
O
1049.00
159.01
760.50
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
EPO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
HMO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
Medicaid
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
Medicare Part A
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
Medicare Part B
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
POS
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
PPO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
humana - medicare advantage
Workers Comp
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
EPO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
HMO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
Medicaid
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
Medicare Part A
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
Medicare Part B
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
POS
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
PPO
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
tricare
Workers Comp
O
1049.00
159.01
159.02
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
EPO
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
HMO
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
Medicaid
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
Medicare Part A
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
Medicare Part B
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
POS
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
PPO
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11102
null
cpt
Tangential biopsy of single skin lesion
va
Workers Comp
O
1049.00
159.01
159.01
760.50
629.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
EPO
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
HMO
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
Medicaid
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
Medicare Part A
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
Medicare Part B
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
POS
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
PPO
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
blue cross blue shield
Workers Comp
O
1126.00
159.02
494.94
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
EPO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
HMO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
Medicaid
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
Medicare Part A
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
Medicare Part B
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
POS
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
PPO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
humana - medicare advantage
Workers Comp
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
EPO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
HMO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
Medicaid
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
Medicare Part A
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
Medicare Part B
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
POS
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
PPO
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11103
null
cpt
Tangential biopsy of additional skin lesion
tricare
Workers Comp
O
1126.00
159.02
159.02
494.94
675.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
EPO
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
HMO
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
Medicaid
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
Medicare Part A
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
Medicare Part B
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
POS
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
PPO
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
blue cross blue shield
Workers Comp
O
846.79
306.29
4671.81
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
EPO
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
HMO
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
Medicaid
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
Medicare Part A
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
Medicare Part B
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
POS
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
PPO
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11104
null
cpt
Punch biopsy of single skin lesion
tricare
Workers Comp
O
846.79
306.29
306.29
4671.81
508.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
EPO
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
HMO
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
POS
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
PPO
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11307
null
cpt
Shaving of 1.1 to 2.0 centimeters skin growth of scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
479.00
479.00
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
EPO
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
HMO
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
Medicaid
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
Medicare Part A
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
Medicare Part B
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
POS
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
PPO
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11400
null
cpt
Removal of growth (0.5 centimeters or less) of the trunk arms or legs
va
Workers Comp
O
11840.23
7888.71
7888.71
7888.71
7104.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
15710.13
1870.25
2360.66
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
EPO
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
HMO
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
POS
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
PPO
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11401
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
15710.13
1870.25
1870.25
2360.66
9426.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11402
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
13400.43
703.99
703.99
703.99
8040.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
15196.01
1241.63
2556.40
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
15196.01
1241.63
1241.63
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
EPO
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
HMO
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
Medicaid
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
Medicare Part A
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
Medicare Part B
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
POS
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
PPO
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11403
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the trunk arms or legs
va
Workers Comp
O
15196.01
1241.63
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
17134.96
1928.98
2173.47
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
EPO
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
HMO
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
POS
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
PPO
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
17134.96
1928.98
1928.98
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11404
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
17134.96
1928.98
2054.26
2173.47
10280.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
15196.01
1246.10
4483.23
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
15196.01
1246.10
2054.26
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
EPO
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
HMO
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
Medicaid
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
Medicare Part A
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
Medicare Part B
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
POS
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
PPO
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
tricare
Workers Comp
O
15196.01
1246.10
1246.10
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
EPO
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
HMO
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
Medicaid
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
Medicare Part A
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
Medicare Part B
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
POS
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
PPO
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11406
null
cpt
Removal of growth (4.0 centimeters) of the trunk arms or legs
va
Workers Comp
O
15196.01
1246.10
7471.49
7471.49
9117.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
EPO
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
HMO
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicaid
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part A
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part B
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
POS
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
PPO
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Workers Comp
O
17614.10
4517.30
5335.38
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
EPO
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
HMO
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
Medicaid
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
Medicare Part A
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
Medicare Part B
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
POS
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
PPO
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11420
null
cpt
Removal of growth (0.5 centimeters or less) of the scalp neck hands feet or genitals
va
Workers Comp
O
17614.10
4517.30
4517.30
5335.38
10568.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
15307.41
525.22
2235.55
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
EPO
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
HMO
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicaid
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part A
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part B
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
POS
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
PPO
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11421
null
cpt
Removal of growth (0.6 to 1.0 centimeters) of the scalp neck hands feet or genitals
tricare
Workers Comp
O
15307.41
525.22
525.22
2235.55
9184.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
14093.63
1121.49
2556.40
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
EPO
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
HMO
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicaid
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part A
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part B
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
POS
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
PPO
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Workers Comp
O
14093.63
1121.49
1870.25
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
EPO
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
HMO
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicaid
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part A
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part B
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
POS
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
PPO
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Workers Comp
O
14093.63
1121.49
1121.49
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
EPO
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
HMO
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicaid
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part A
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part B
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
POS
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
PPO
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11422
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
tricare
Workers Comp
O
14093.63
1121.49
1215.96
2556.40
8456.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
14935.53
1215.96
2631.83
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
EPO
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
HMO
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicaid
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part A
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part B
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
POS
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
PPO
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Workers Comp
O
14935.53
1215.96
2455.02
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
EPO
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
HMO
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicaid
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part A
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part B
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
POS
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
PPO
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11423
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
tricare
Workers Comp
O
14935.53
1215.96
1215.96
2631.83
8961.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
16181.67
3849.84
4587.73
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
EPO
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
HMO
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicaid
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part A
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part B
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
POS
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
PPO
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Workers Comp
O
16181.67
3849.84
3849.84
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
EPO
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
HMO
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
Medicaid
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
Medicare Part A
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
Medicare Part B
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
POS
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
PPO
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11424
null
cpt
Removal of growth (3.1 to 4.0 centimeters) of the scalp neck hands feet or genitals
united healthcare
Workers Comp
O
16181.67
3849.84
12136.25
12136.25
9709.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
EPO
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
HMO
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicaid
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part A
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
Medicare Part B
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
POS
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
PPO
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11426
null
cpt
Removal of growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
tricare
Workers Comp
O
12507.00
2098.98
2098.98
2098.98
7504.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
EPO
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
HMO
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
Medicaid
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part A
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part B
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
POS
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
PPO
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
humana - medicare advantage
Workers Comp
O
16765.79
550.84
627.42
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
EPO
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
HMO
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
Medicaid
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
Medicare Part A
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
Medicare Part B
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
POS
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
PPO
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11442
null
cpt
Removal of growth (1.1 to 2.0 centimeters) of the face ears eyelids nose lips or mouth
tricare
Workers Comp
O
16765.79
550.84
550.84
627.42
10059.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
EPO
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
HMO
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicaid
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part A
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part B
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
POS
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
PPO
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11443
null
cpt
Removal of growth (2.1 to 3.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Workers Comp
O
13518.78
996.88
996.88
996.88
8111.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
EPO
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
HMO
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
Medicaid
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
Medicare Part A
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
Medicare Part B
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
POS
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
PPO
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11450
null
cpt
Removal of skin and tissue beneath the skin of underarms for excessive sweating simple
tricare
Workers Comp
O
16761.93
2054.26
2054.26
2054.26
10057.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
EPO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
HMO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
Medicaid
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
Medicare Part A
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
Medicare Part B
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
POS
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
PPO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11601
null
cpt
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk arms or legs
tricare
Workers Comp
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
3138.00
459.44
2217.32
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11602
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
3138.00
459.44
459.44
2217.32
1882.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11603
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
2584.00
703.99
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11604
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
8412.49
2159.44
2159.44
2159.44
5047.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
EPO
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
HMO
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
Medicaid
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
Medicare Part A
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
Medicare Part B
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
POS
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
PPO
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
aetna
Workers Comp
O
16928.96
1215.96
9591.25
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
EPO
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
HMO
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicaid
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part A
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Medicare Part B
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
POS
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
PPO
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield
Workers Comp
O
16928.96
1215.96
5970.34
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
EPO
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
HMO
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
POS
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
PPO
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
16928.96
1215.96
1215.96
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
EPO
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
HMO
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicaid
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part A
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Medicare Part B
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
POS
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
PPO
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11606
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the trunk arms or legs
humana - medicare advantage
Workers Comp
O
16928.96
1215.96
3058.52
9591.25
10157.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11622
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
3654.00
2458.09
2458.09
2458.09
2192.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11623
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
10391.70
2608.90
2608.90
2608.90
6235.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
EPO
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
HMO
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicaid
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part A
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Medicare Part B
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
POS
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
PPO
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11624
null
cpt
Removal of malignant growth (3.1 to 4 centimeters) of the scalp neck hands feet or genitals
humana - medicare advantage
Workers Comp
O
17744.54
1215.96
1215.96
1215.96
10646.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
EPO
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
HMO
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
POS
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
PPO
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11626
null
cpt
Removal of malignant growth (over 4.0 centimeters) of the scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
16787.67
6577.97
6577.97
6577.97
10072.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
EPO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
HMO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
Medicaid
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
Medicare Part A
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
Medicare Part B
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
POS
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
PPO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11640
null
cpt
Removal of malignant growth (0.5 centimeters or less) of the face ears eyelids nose or lips
humana - medicare advantage
Workers Comp
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
EPO
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
HMO
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
Medicaid
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
Medicare Part A
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
Medicare Part B
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
POS
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
PPO
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
humana - medicare advantage
Workers Comp
O
2584.00
703.96
703.99
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
EPO
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
HMO
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
Medicaid
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
Medicare Part A
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
Medicare Part B
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
POS
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
PPO
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11642
null
cpt
Removal of malignant growth (1.1 to 2.0 centimeters) of the face ears eyelids nose or lips
va
Workers Comp
O
2584.00
703.96
703.96
703.99
1550.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
EPO
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
HMO
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicaid
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicare Part A
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicare Part B
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
POS
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
PPO
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11643
null
cpt
Removal of malignant growth (2.1 to 3.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Workers Comp
O
14753.10
1215.96
1215.96
1215.96
8851.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
EPO
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
HMO
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicaid
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicare Part A
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Medicare Part B
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
POS
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
PPO
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
aetna - medicare advantage
Workers Comp
O
16054.93
1215.96
1215.96
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
EPO
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
HMO
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
Medicaid
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
Medicare Part A
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
Medicare Part B
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
POS
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
PPO
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11644
null
cpt
Removal of malignant growth (3.1 to 4.0 centimeters) of the face ears eyelids nose or lips
blue cross blue shield
Workers Comp
O
16054.93
1215.96
5287.17
5287.17
9632.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
EPO
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
HMO
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
Medicaid
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
Medicare Part A
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
Medicare Part B
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
POS
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
PPO
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11750
null
cpt
Removal of nail
tricare
Workers Comp
O
1242.32
276.95
276.95
276.95
745.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
EPO
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
HMO
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
Medicaid
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
Medicare Part A
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
Medicare Part B
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
POS
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
PPO
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11760
null
cpt
Repair of finger or toe nail bed
tricare
Workers Comp
O
15876.12
2054.26
2054.26
2054.26
9525.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
EPO
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
HMO
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
Medicaid
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
Medicare Part A
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
Medicare Part B
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
POS
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
PPO
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
blue cross blue shield
Workers Comp
O
15615.40
4573.79
4573.79
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
EPO
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
HMO
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
Medicaid
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
Medicare Part A
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
Medicare Part B
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
POS
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
PPO
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11771
null
cpt
Removal of tailbone cyst extensive
united healthcare
Workers Comp
O
15615.40
4573.79
11714.97
11714.97
9369.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
EPO
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
HMO
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
Medicaid
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
Medicare Part A
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
Medicare Part B
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
POS
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
PPO
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
11772
null
cpt
Removal of tailbone cyst complicated
blue cross blue shield
Workers Comp
O
19171.17
4501.26
4501.26
4501.26
11502.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
EPO
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
HMO
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicaid
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part A
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part B
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
POS
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
PPO
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Workers Comp
O
14027.14
581.72
3512.63
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
EPO
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
HMO
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
Medicaid
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
POS
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
PPO
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield - medicare advantage
Workers Comp
O
14027.14
581.72
2889.41
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
EPO
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
HMO
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicaid
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicare Part A
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicare Part B
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
POS
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
PPO
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Workers Comp
O
14027.14
581.72
581.72
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
EPO
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
HMO
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicaid
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicare Part A
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicare Part B
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
POS
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
PPO
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12032
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Workers Comp
O
14027.14
581.72
1246.10
3512.63
8416.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
EPO
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
HMO
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicaid
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part A
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part B
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
POS
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
PPO
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Workers Comp
O
15561.64
2098.98
5337.60
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
EPO
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
HMO
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicaid
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicare Part A
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Medicare Part B
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
POS
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
PPO
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
humana - medicare advantage
Workers Comp
O
15561.64
2098.98
4901.08
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
EPO
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
HMO
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicaid
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicare Part A
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Medicare Part B
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
POS
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
PPO
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12034
null
cpt
Repair of wound (7.6 to 12.5 centimeters) of the scalp underarms trunk arms and/or legs
tricare
Workers Comp
O
15561.64
2098.98
2098.98
5337.60
9336.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
EPO
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
HMO
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicaid
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part A
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Medicare Part B
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
POS
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
PPO
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12036
null
cpt
Repair of wound (20.1 to 30.0 centimeters) of the scalp underarms trunk arms and/or legs
blue cross blue shield
Workers Comp
O
29426.02
4483.23
4483.23
4483.23
17655.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
EPO
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
HMO
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
Medicaid
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
Medicare Part A
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
Medicare Part B
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
POS
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
PPO
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12041
null
cpt
Repair of wound (2.5 centimeters or less) of neck hands feet and/or genitals
tricare
Workers Comp
O
2467.89
883.40
883.40
883.40
1480.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
EPO
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
HMO
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
Medicaid
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
Medicare Part A
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
Medicare Part B
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
POS
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
PPO
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
blue cross blue shield
Workers Comp
O
4555.00
1215.96
2608.90
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
EPO
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
HMO
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
Medicaid
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
Medicare Part A
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
Medicare Part B
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
POS
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
PPO
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
humana - medicare advantage
Workers Comp
O
4555.00
1215.96
2455.02
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
EPO
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
HMO
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
Medicaid
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
Medicare Part A
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
Medicare Part B
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
POS
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
PPO
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12042
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of neck hands feet and/or genitals
tricare
Workers Comp
O
4555.00
1215.96
1215.96
2608.90
2733.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
EPO
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
HMO
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicaid
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicare Part A
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicare Part B
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
POS
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
PPO
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12051
null
cpt
Repair of wound (2.5 centimeters or less) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Workers Comp
O
15414.98
703.99
703.99
703.99
9248.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
EPO
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
HMO
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
Medicaid
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
Medicare Part A
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
Medicare Part B
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
POS
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
PPO
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
aetna - medicare advantage
Workers Comp
O
13690.31
703.96
1215.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
EPO
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
HMO
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
Medicaid
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
Medicare Part A
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
Medicare Part B
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
POS
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
PPO
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
blue cross blue shield
Workers Comp
O
13690.31
703.96
5287.17
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
EPO
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
HMO
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicaid
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicare Part A
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Medicare Part B
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
POS
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
PPO
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
humana - medicare advantage
Workers Comp
O
13690.31
703.96
703.99
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
EPO
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
HMO
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
Medicaid
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
Medicare Part A
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
Medicare Part B
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
POS
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
PPO
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
12052
null
cpt
Repair of wound (2.6 to 5.0 centimeters) of face ears eyelids nose lips and/or mouth
va
Workers Comp
O
13690.31
703.96
703.96
5287.17
8214.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
EPO
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
HMO
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
Medicaid
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
Medicare Part A
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
Medicare Part B
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
POS
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
PPO
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield
Workers Comp
I
20093.11
6304.24
8425.13
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
EPO
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
HMO
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
Medicaid
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
Medicare Part A
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
Medicare Part B
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
POS
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
PPO
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
123
null
ms-drg
neurological eye disorders
blue cross blue shield - medicare advantage
Workers Comp
I
20093.11
6304.24
6304.24
8425.13
12055.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
EPO
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
HMO
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
Medicaid
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
Medicare Part A
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
Medicare Part B
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
POS
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
PPO
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13101
null
cpt
Repair of wound (2.6 to 7.5 centimeters) of trunk
blue cross blue shield
Workers Comp
O
17012.94
3991.84
3991.84
3991.84
10207.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
EPO
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
HMO
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
Medicaid
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
Medicare Part A
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
Medicare Part B
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
POS
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
PPO
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13102
null
cpt
Repair of wound of trunk
blue cross blue shield
Workers Comp
O
17793.03
3991.84
3991.84
3991.84
10675.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
EPO
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
HMO
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
Medicaid
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
Medicare Part A
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
Medicare Part B
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
POS
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
PPO
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
13160
null
cpt
Second repair of surgical wound
tricare
Workers Comp
O
22970.15
1613.57
1613.57
1613.57
13782.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
EPO
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
HMO
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
Medicaid
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
Medicare Part A
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
Medicare Part B
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
POS
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
PPO
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14041
null
cpt
Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead cheeks chin mouth neck underarms genitals hands and/or feet
aetna - medicare advantage
Workers Comp
O
4580.00
1519.19
1519.19
1519.19
2748.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
EPO
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
HMO
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
Medicaid
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
Medicare Part A
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
Medicare Part B
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
POS
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
PPO
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
14350
null
cpt
Repair of tissue loss of finger or toe
blue cross blue shield - medicare advantage
Workers Comp
O
18559.67
6315.11
6315.11
6315.11
11135.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
EPO
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
HMO
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
Medicaid
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
Medicare Part A
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
Medicare Part B
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
POS
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
PPO
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15100
null
cpt
Partial thickness skin graft at trunk arms or legs (first 100 sq cm or less or 1% body are of infants and children)
blue cross blue shield
Workers Comp
O
19579.68
6603.11
6603.11
6603.11
11747.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
EPO
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
HMO
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
Medicaid
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
Medicare Part A
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
Medicare Part B
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
POS
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
PPO
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
tricare
Workers Comp
O
18704.92
2683.82
2683.82
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
EPO
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
HMO
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
Medicaid
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
Medicare Part A
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
Medicare Part B
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
POS
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
PPO
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15120
null
cpt
Partial thickness skin graft of face scalp eyelids mouth neck ears eye region genitals hands feet and/or multiple fingers or toes (first 100 sq cm or less or 1% body area of infants and children)
united healthcare
Workers Comp
O
18704.92
2683.82
11689.03
11689.03
11222.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
EPO
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
HMO
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
Medicaid
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
Medicare Part A
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
Medicare Part B
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
POS
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
PPO
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15220
null
cpt
Relocation of patient skin (20 sq centimeters or less) to scalp arms and/or legs
blue cross blue shield
Workers Comp
O
18723.29
8613.38
8613.38
8613.38
11233.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
EPO
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
HMO
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
Medicaid
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
Medicare Part A
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
Medicare Part B
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
POS
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
PPO
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15221
null
cpt
Relocation of patient skin to scalp arms and/or legs
blue cross blue shield
Workers Comp
O
24353.56
8613.38
8613.38
8613.38
14612.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
EPO
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
HMO
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
Medicaid
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
Medicare Part A
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
Medicare Part B
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
POS
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
PPO
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
blue cross blue shield
Workers Comp
O
6056.44
1519.14
2003.23
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
EPO
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
HMO
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
Medicaid
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
Medicare Part A
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
Medicare Part B
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
POS
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
PPO
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
tricare
Workers Comp
O
6056.44
1519.14
2262.26
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
EPO
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
HMO
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
Medicaid
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
Medicare Part A
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
Medicare Part B
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
POS
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
PPO
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15271
null
cpt
Application of skin substitute (wound surface up to 100 sq cm) to trunk arms or legs (first 25 sq cm or less)
va
Workers Comp
O
6056.44
1519.14
1519.14
2262.26
3633.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
EPO
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
HMO
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
Medicaid
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
Medicare Part A
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
Medicare Part B
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
POS
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
PPO
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield
Workers Comp
O
19151.08
2485.70
2485.70
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
EPO
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
HMO
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
Medicaid
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
Medicare Part A
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
Medicare Part B
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
POS
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
PPO
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15273
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs (first 100 sq cm or 1% body area of infants and children)
blue cross blue shield - medicare advantage
Workers Comp
O
19151.08
2485.70
2927.33
2927.33
11490.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
EPO
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
HMO
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
POS
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
PPO
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15274
null
cpt
Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
20843.75
2927.33
2927.33
2927.33
12506.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
EPO
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
HMO
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
Medicaid
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
Medicare Part A
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
Medicare Part B
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
POS
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
PPO
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
blue cross blue shield
Workers Comp
I
20193.19
3135.80
4648.14
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
EPO
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
HMO
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
Medicaid
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
Medicare Part A
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
Medicare Part B
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
POS
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
PPO
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
153
null
ms-drg
otitis media and uri without mcc
tricare
Workers Comp
I
20193.19
3135.80
3135.80
4648.14
12115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
EPO
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
HMO
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
Medicaid
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
Medicare Part A
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
Medicare Part B
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
POS
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
PPO
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
155
null
ms-drg
other ear nose mouth and throat diagnoses with cc
va
Workers Comp
I
11205.49
6007.39
6007.39
6007.39
6723.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
EPO
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
HMO
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
Medicaid
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
Medicare Part A
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
Medicare Part B
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
POS
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
PPO
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15734
null
cpt
Muscle flap wound repair at trunk
humana - medicare advantage
Workers Comp
O
25246.00
7309.85
7309.85
7309.85
15147.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
EPO
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
HMO
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
Medicaid
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
Medicare Part A
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
Medicare Part B
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
POS
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
PPO
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
humana - medicare advantage
Workers Comp
O
26014.96
2423.46
2423.46
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
EPO
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
HMO
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
Medicaid
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
Medicare Part A
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
Medicare Part B
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
POS
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
PPO
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
15769
null
cpt
Grafting of patient soft tissue harvested by direct excision
tricare
Workers Comp
O
26014.96
2423.46
7920.95
7920.95
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
EPO
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
HMO
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
Medicaid
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
Medicare Part A
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
Medicare Part B
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
POS
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
PPO
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
tricare
Workers Comp
I
17527.53
4912.52
4912.52
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
EPO
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
HMO
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
Medicaid
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
Medicare Part A
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
Medicare Part B
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
POS
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
PPO
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
158
null
ms-drg
dental and oral diseases with cc
united healthcare
Workers Comp
I
17527.53
4912.52
9311.37
9311.37
10516.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
EPO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
HMO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
Medicaid
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
Medicare Part A
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
Medicare Part B
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
POS
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
PPO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
humana - medicare advantage
Workers Comp
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
EPO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
HMO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
Medicaid
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
Medicare Part A
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
Medicare Part B
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
POS
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
PPO
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
tricare
Workers Comp
O
413.62
159.01
159.02
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
EPO
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
HMO
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
Medicaid
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
Medicare Part A
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
Medicare Part B
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
POS
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
PPO
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
16020
null
cpt
Dressing change and/or removal of burn tissue (less than 5% total body surface)
va
Workers Comp
O
413.62
159.01
159.01
159.02
248.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
EPO
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
HMO
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
Medicaid
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
Medicare Part A
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
Medicare Part B
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
POS
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
PPO
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
humana - medicare advantage
Workers Comp
I
100044.29
24674.98
24674.98
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
EPO
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
HMO
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
Medicaid
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
Medicare Part A
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
Medicare Part B
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
POS
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
PPO
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
163
null
ms-drg
major chest procedures with mcc
tricare
Workers Comp
I
100044.29
24674.98
25423.48
25423.48
60026.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
EPO
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
HMO
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
POS
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
PPO
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
164
null
ms-drg
major chest procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
88936.21
21169.83
21169.83
21169.83
53361.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
EPO
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
HMO
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
Medicaid
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
POS
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
PPO
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
blue cross blue shield
Workers Comp
I
67111.50
11400.92
21792.66
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
EPO
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
HMO
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
Medicaid
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
POS
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
PPO
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
67111.50
11400.92
11400.92
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
EPO
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
HMO
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
Medicaid
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
Medicare Part A
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
Medicare Part B
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
POS
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
PPO
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
tricare
Workers Comp
I
67111.50
11400.92
11773.80
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
EPO
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
HMO
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
Medicaid
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
Medicare Part A
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
Medicare Part B
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
POS
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
PPO
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
165
null
ms-drg
major chest procedures without cc/mcc
va
Workers Comp
I
67111.50
11400.92
18098.60
21792.66
40266.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
EPO
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
HMO
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
Medicaid
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
Medicare Part A
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
Medicare Part B
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
POS
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
PPO
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
166
null
ms-drg
other respiratory system o.r. procedures with mcc
humana - medicare advantage
Workers Comp
I
64916.34
19717.45
19717.45
19717.45
38949.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
EPO
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
HMO
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
Medicaid
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
Medicare Part A
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
Medicare Part B
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
POS
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
PPO
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
167
null
ms-drg
other respiratory system o.r. procedures with cc
tricare
Workers Comp
I
50884.34
5702.35
5702.35
5702.35
30530.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
POS
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
168
null
ms-drg
other respiratory system o.r. procedures without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
66025.69
10598.06
10598.06
10598.06
39615.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
EPO
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
HMO
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
Medicaid
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
Medicare Part A
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
Medicare Part B
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
POS
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
PPO
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
aetna - medicare advantage
Workers Comp
O
958.00
139.15
232.66
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
EPO
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
HMO
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
Medicaid
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
Medicare Part A
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
Medicare Part B
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
POS
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
PPO
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
blue cross blue shield
Workers Comp
O
958.00
139.15
743.55
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
EPO
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
HMO
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
Medicaid
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
Medicare Part A
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
Medicare Part B
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
POS
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
PPO
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
humana - medicare advantage
Workers Comp
O
958.00
139.15
139.15
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
EPO
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
HMO
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
Medicaid
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
Medicare Part A
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
Medicare Part B
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
POS
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
PPO
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
tricare
Workers Comp
O
958.00
139.15
159.02
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
EPO
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
HMO
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
Medicaid
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
Medicare Part A
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
Medicare Part B
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
POS
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
PPO
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17000
null
cpt
Destruction of skin growth
va
Workers Comp
O
958.00
139.15
159.01
743.55
574.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
EPO
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
HMO
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
Medicaid
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
Medicare Part A
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
Medicare Part B
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
POS
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
PPO
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
aetna - medicare advantage
Workers Comp
O
970.00
159.01
232.66
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
EPO
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
HMO
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
Medicaid
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
Medicare Part A
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
Medicare Part B
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
POS
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
PPO
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
blue cross blue shield
Workers Comp
O
970.00
159.01
617.28
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
EPO
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
HMO
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
Medicaid
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
Medicare Part A
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
Medicare Part B
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
POS
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
PPO
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
humana - medicare advantage
Workers Comp
O
970.00
159.01
306.29
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
EPO
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
HMO
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
Medicaid
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
Medicare Part A
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
Medicare Part B
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
POS
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
PPO
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
tricare
Workers Comp
O
970.00
159.01
159.02
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
EPO
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
HMO
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
Medicaid
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
Medicare Part A
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
Medicare Part B
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
POS
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
PPO
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17003
null
cpt
Destruction of 2-14 skin growths
va
Workers Comp
O
970.00
159.01
159.01
617.28
582.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
EPO
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
HMO
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
Medicaid
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
Medicare Part A
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
Medicare Part B
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
POS
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
PPO
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17004
null
cpt
Destruction of 15 or more premalignant skin growths
humana - medicare advantage
Workers Comp
O
1486.00
245.03
245.03
245.03
891.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
EPO
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
HMO
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
Medicaid
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
Medicare Part A
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
Medicare Part B
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
POS
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
PPO
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
blue cross blue shield
Workers Comp
O
479.00
159.01
479.00
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
EPO
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
HMO
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
Medicaid
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
Medicare Part A
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
Medicare Part B
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
POS
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
PPO
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17110
null
cpt
Destruction of up to 14 skin growths
va
Workers Comp
O
479.00
159.01
159.01
479.00
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
EPO
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
HMO
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
Medicaid
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
Medicare Part A
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
Medicare Part B
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
POS
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
PPO
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
blue cross blue shield - medicare advantage
Workers Comp
O
971.75
159.01
588.75
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
EPO
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
HMO
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
Medicaid
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
Medicare Part A
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
Medicare Part B
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
POS
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
PPO
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17250
null
cpt
Application of chemical agent to excessive wound tissue
va
Workers Comp
O
971.75
159.01
159.01
588.75
583.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
EPO
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
HMO
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
Medicaid
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
Medicare Part A
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
Medicare Part B
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
POS
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
PPO
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17260
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of trunk arms or legs
humana - medicare advantage
Workers Comp
O
1724.50
623.16
623.16
623.16
1034.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
EPO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
HMO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
Medicaid
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
Medicare Part A
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
Medicare Part B
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
POS
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
PPO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
aetna
Workers Comp
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
EPO
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
HMO
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
POS
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
PPO
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
2120.00
159.02
543.72
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
EPO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
HMO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicaid
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicare Part A
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicare Part B
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
POS
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
PPO
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17261
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of trunk arms or legs
humana - medicare advantage
Workers Comp
O
2120.00
159.02
159.02
543.72
1272.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
EPO
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
HMO
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
Medicaid
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
Medicare Part A
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
Medicare Part B
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
POS
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
PPO
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
blue cross blue shield
Workers Comp
O
479.00
159.02
217.11
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
EPO
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
HMO
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicaid
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicare Part A
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
Medicare Part B
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
POS
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
PPO
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17262
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of trunk arms or legs
humana - medicare advantage
Workers Comp
O
479.00
159.02
159.02
217.11
287.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
EPO
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
HMO
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
Medicaid
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
Medicare Part A
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
Medicare Part B
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
POS
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
PPO
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17264
null
cpt
Destruction of malignant growth (3.1 to 4.0 centimeters) of trunk arms or legs
aetna - medicare advantage
Workers Comp
O
1456.00
306.29
306.29
306.29
873.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
EPO
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
HMO
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
Medicaid
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
Medicare Part A
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
Medicare Part B
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
POS
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
PPO
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield
Workers Comp
O
1713.00
543.72
1044.00
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
EPO
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
HMO
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicaid
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part A
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Medicare Part B
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
POS
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
PPO
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17271
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of scalp neck hands feet or genitals
blue cross blue shield - medicare advantage
Workers Comp
O
1713.00
543.72
543.72
1044.00
1027.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
EPO
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
HMO
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicaid
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part A
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part B
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
POS
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
PPO
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
humana - medicare advantage
Workers Comp
O
1545.00
159.01
306.29
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
EPO
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
HMO
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
Medicaid
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
Medicare Part A
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
Medicare Part B
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
POS
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
PPO
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17280
null
cpt
Destruction of malignant growth (0.5 centimeters or less) of face ears eyelids nose lips or mouth
va
Workers Comp
O
1545.00
159.01
159.01
306.29
927.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
EPO
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
HMO
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicaid
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part A
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part B
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
POS
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
PPO
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17281
null
cpt
Destruction of malignant growth (0.6 to 1.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Workers Comp
O
2384.00
275.66
275.66
275.66
1430.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
EPO
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
HMO
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicaid
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part A
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Medicare Part B
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
POS
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
PPO
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17282
null
cpt
Destruction of malignant growth (1.1 to 2.0 centimeters) of face ears eyelids nose lips or mouth
humana - medicare advantage
Workers Comp
O
3109.50
623.16
623.16
623.16
1865.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
EPO
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
HMO
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
Medicaid
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
Medicare Part A
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
Medicare Part B
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
POS
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
PPO
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
blue cross blue shield - medicare advantage
Workers Comp
I
33912.14
6938.47
12055.04
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
EPO
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
HMO
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
Medicaid
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
Medicare Part A
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
Medicare Part B
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
POS
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
PPO
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
humana - medicare advantage
Workers Comp
I
33912.14
6938.47
6938.47
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
EPO
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
HMO
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
Medicaid
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
Medicare Part A
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
Medicare Part B
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
POS
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
PPO
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
175
null
ms-drg
pulmonary embolism with mcc or acute cor pulmonale
tricare
Workers Comp
I
33912.14
6938.47
8171.40
12055.04
20347.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
EPO
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
HMO
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
Medicaid
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
Medicare Part A
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
Medicare Part B
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
POS
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
PPO
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
aetna - medicare advantage
Workers Comp
I
17961.90
4967.80
5931.05
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
EPO
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
HMO
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
Medicaid
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
Medicare Part A
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
Medicare Part B
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
POS
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
PPO
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield
Workers Comp
I
17961.90
4967.80
11252.92
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
EPO
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
HMO
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
Medicaid
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
POS
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
PPO
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
17961.90
4967.80
7352.28
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
EPO
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
HMO
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
Medicaid
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
Medicare Part A
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
Medicare Part B
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
POS
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
PPO
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
humana - medicare advantage
Workers Comp
I
17961.90
4967.80
5733.47
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
EPO
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
HMO
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
Medicaid
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
Medicare Part A
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
Medicare Part B
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
POS
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
PPO
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
tricare
Workers Comp
I
17961.90
4967.80
4967.80
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
EPO
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
HMO
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
Medicaid
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
Medicare Part A
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
Medicare Part B
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
POS
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
PPO
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
176
null
ms-drg
pulmonary embolism without mcc
va
Workers Comp
I
17961.90
4967.80
6060.50
11252.92
10777.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
EPO
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
HMO
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
Medicaid
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
Medicare Part A
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
Medicare Part B
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
POS
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
PPO
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield
Workers Comp
I
27315.09
6218.17
17698.24
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
EPO
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
HMO
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
Medicaid
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
POS
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
PPO
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
27315.09
6218.17
15199.80
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
EPO
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
HMO
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
Medicaid
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
Medicare Part A
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
Medicare Part B
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
POS
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
PPO
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
humana - medicare advantage
Workers Comp
I
27315.09
6218.17
13412.51
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
EPO
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
HMO
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
Medicaid
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
Medicare Part A
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
Medicare Part B
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
POS
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
PPO
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
tricare
Workers Comp
I
27315.09
6218.17
10490.74
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
EPO
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
HMO
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
Medicaid
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
Medicare Part A
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
Medicare Part B
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
POS
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
PPO
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
va
Workers Comp
I
27315.09
6218.17
13848.95
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
EPO
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
HMO
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
Medicaid
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
Medicare Part A
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
Medicare Part B
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
POS
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
PPO
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
177
null
ms-drg
respiratory infections and inflammations with mcc
webtpa
Workers Comp
I
27315.09
6218.17
6218.17
17698.24
16389.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
EPO
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
HMO
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
Medicaid
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
Medicare Part A
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
Medicare Part B
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
POS
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
PPO
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield
Workers Comp
I
18905.27
6114.16
14571.00
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
EPO
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
HMO
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
Medicaid
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
POS
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
PPO
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
blue cross blue shield - medicare advantage
Workers Comp
I
18905.27
6114.16
10637.48
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
EPO
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
HMO
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
Medicaid
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
Medicare Part A
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
Medicare Part B
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
POS
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
PPO
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
humana - medicare advantage
Workers Comp
I
18905.27
6114.16
9326.33
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
EPO
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
HMO
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
Medicaid
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
Medicare Part A
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
Medicare Part B
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
POS
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
PPO
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
tricare
Workers Comp
I
18905.27
6114.16
6114.16
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
EPO
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
HMO
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
Medicaid
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
Medicare Part A
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
Medicare Part B
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
POS
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
PPO
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
178
null
ms-drg
respiratory infections and inflammations with cc
va
Workers Comp
I
18905.27
6114.16
8105.66
14571.00
11343.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
EPO
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
HMO
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
Medicaid
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
Medicare Part A
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
Medicare Part B
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
POS
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
PPO
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
blue cross blue shield
Workers Comp
I
12388.64
4054.24
9383.54
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
EPO
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
HMO
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
Medicaid
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
Medicare Part A
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
Medicare Part B
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
POS
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
PPO
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
179
null
ms-drg
respiratory infections and inflammations without cc/mcc
tricare
Workers Comp
I
12388.64
4054.24
4054.24
9383.54
7433.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
EPO
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
HMO
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
Medicaid
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
Medicare Part A
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
Medicare Part B
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
POS
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
PPO
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
humana - medicare advantage
Workers Comp
O
19851.82
1215.96
1215.96
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
EPO
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
HMO
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
Medicaid
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
Medicare Part A
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
Medicare Part B
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
POS
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
PPO
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
17999
null
cpt
Skin mucus membrane and beneath the skin procedure
va
Workers Comp
O
19851.82
1215.96
1553.71
1553.71
11911.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
EPO
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
HMO
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
Medicaid
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
Medicare Part A
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
Medicare Part B
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
POS
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
PPO
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
180
null
ms-drg
respiratory neoplasms with mcc
humana - medicare advantage
Workers Comp
I
53062.71
10932.27
10932.27
10932.27
31837.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
EPO
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
HMO
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
Medicaid
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
Medicare Part A
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
Medicare Part B
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
POS
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
PPO
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
blue cross blue shield
Workers Comp
I
75077.95
8304.87
12128.96
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
EPO
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
HMO
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
Medicaid
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
Medicare Part A
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
Medicare Part B
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
POS
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
PPO
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
183
null
ms-drg
major chest trauma with mcc
humana - medicare advantage
Workers Comp
I
75077.95
8304.87
8304.87
12128.96
45046.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
EPO
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
HMO
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
Medicaid
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
Medicare Part A
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
Medicare Part B
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
POS
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
PPO
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
blue cross blue shield
Workers Comp
I
19541.52
6171.27
9706.44
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
EPO
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
HMO
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
Medicaid
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
Medicare Part A
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
Medicare Part B
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
POS
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
PPO
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
184
null
ms-drg
major chest trauma with cc
humana - medicare advantage
Workers Comp
I
19541.52
6171.27
6171.27
9706.44
11724.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
EPO
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
HMO
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
Medicaid
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
Medicare Part A
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
Medicare Part B
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
POS
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
PPO
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
blue cross blue shield
Workers Comp
I
28930.07
8291.36
9567.47
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
EPO
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
HMO
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
Medicaid
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
Medicare Part A
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
Medicare Part B
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
POS
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
PPO
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
186
null
ms-drg
pleural effusion with mcc
humana - medicare advantage
Workers Comp
I
28930.07
8291.36
8291.36
9567.47
17358.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
EPO
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
HMO
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
Medicaid
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
Medicare Part A
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
Medicare Part B
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
POS
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
PPO
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield
Workers Comp
I
29753.01
7278.32
11706.17
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
EPO
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
HMO
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
Medicaid
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
Medicare Part A
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
Medicare Part B
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
POS
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
PPO
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
blue cross blue shield - medicare advantage
Workers Comp
I
29753.01
7278.32
10266.59
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
EPO
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
HMO
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
Medicaid
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
Medicare Part A
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
Medicare Part B
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
POS
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
PPO
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
189
null
ms-drg
pulmonary edema and respiratory failure
humana - medicare advantage
Workers Comp
I
29753.01
7278.32
7278.32
11706.17
17851.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
EPO
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
HMO
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
Medicaid
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
Medicare Part A
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
Medicare Part B
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
POS
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
PPO
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
aetna - medicare advantage
Workers Comp
I
22755.17
6429.67
7182.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
EPO
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
HMO
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
Medicaid
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
Medicare Part A
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
Medicare Part B
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
POS
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
PPO
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield
Workers Comp
I
22755.17
6429.67
11022.31
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
EPO
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
HMO
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
Medicaid
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
POS
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
PPO
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
22755.17
6429.67
9773.46
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
EPO
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
HMO
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
Medicaid
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
Medicare Part A
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
Medicare Part B
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
POS
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
PPO
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
humana - medicare advantage
Workers Comp
I
22755.17
6429.67
6429.67
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
EPO
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
HMO
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
Medicaid
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
Medicare Part A
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
Medicare Part B
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
POS
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
PPO
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
190
null
ms-drg
chronic obstructive pulmonary disease with mcc
va
Workers Comp
I
22755.17
6429.67
7668.96
11022.31
13653.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
EPO
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
HMO
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
Medicaid
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
Medicare Part A
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
Medicare Part B
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
POS
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
PPO
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
blue cross blue shield
Workers Comp
O
2094.48
540.40
1936.63
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
EPO
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
HMO
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
Medicaid
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
Medicare Part A
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
Medicare Part B
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
POS
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
PPO
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19000
null
cpt
Aspiration of breast cyst
humana - medicare advantage
Workers Comp
O
2094.48
540.40
540.40
1936.63
1256.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
EPO
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
HMO
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
Medicaid
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
Medicare Part A
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
Medicare Part B
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
POS
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
PPO
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19020
null
cpt
Drainage of breast abscess
blue cross blue shield - medicare advantage
Workers Comp
O
14427.27
1061.57
1061.57
1061.57
8656.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
EPO
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
HMO
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
Medicaid
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
Medicare Part A
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
Medicare Part B
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
POS
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
PPO
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield
Workers Comp
O
9682.59
1215.96
3480.89
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
EPO
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
HMO
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
Medicaid
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
Medicare Part A
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
Medicare Part B
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
POS
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
PPO
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
blue cross blue shield - medicare advantage
Workers Comp
O
9682.59
1215.96
3561.58
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
EPO
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
HMO
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
Medicaid
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
Medicare Part A
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
Medicare Part B
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
POS
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
PPO
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
humana - medicare advantage
Workers Comp
O
9682.59
1215.96
1215.96
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
EPO
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
HMO
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
Medicaid
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
Medicare Part A
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
Medicare Part B
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
POS
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
PPO
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
tricare
Workers Comp
O
9682.59
1215.96
1231.03
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
EPO
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
HMO
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
Medicaid
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
Medicare Part A
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
Medicare Part B
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
POS
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
PPO
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19081
null
cpt
Biopsy of breast accessed through the skin with stereotactic guidance first lesion
va
Workers Comp
O
9682.59
1215.96
2098.90
3561.58
5809.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
EPO
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
HMO
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
Medicaid
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
Medicare Part A
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
Medicare Part B
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
POS
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
PPO
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna
Workers Comp
O
8116.24
1172.05
5793.76
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
EPO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
HMO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
Medicaid
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
Medicare Part A
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
Medicare Part B
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
POS
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
PPO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
aetna - medicare advantage
Workers Comp
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
EPO
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
HMO
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicaid
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicare Part A
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicare Part B
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
POS
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
PPO
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Workers Comp
O
8116.24
1172.05
4093.19
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
EPO
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
HMO
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
Medicaid
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
Medicare Part A
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
Medicare Part B
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
POS
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
PPO
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
blue cross blue shield - medicare advantage
Workers Comp
O
8116.24
1172.05
3205.26
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
EPO
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
HMO
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicaid
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicare Part A
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicare Part B
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
POS
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
PPO
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Workers Comp
O
8116.24
1172.05
1246.10
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
EPO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
HMO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
Medicaid
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
Medicare Part A
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
Medicare Part B
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
POS
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
PPO
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
tricare
Workers Comp
O
8116.24
1172.05
1215.96
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
EPO
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
HMO
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
Medicaid
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
Medicare Part A
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
Medicare Part B
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
POS
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
PPO
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare
Workers Comp
O
8116.24
1172.05
6228.87
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
EPO
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
HMO
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
Medicaid
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
Medicare Part A
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
Medicare Part B
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
POS
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
PPO
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19083
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance first lesion
united healthcare - medicare advantage
Workers Comp
O
8116.24
1172.05
1172.05
6228.87
4869.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
EPO
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
HMO
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
Medicaid
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
Medicare Part A
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
Medicare Part B
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
POS
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
PPO
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
aetna
Workers Comp
O
11263.11
1295.62
6068.11
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
EPO
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
HMO
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicaid
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicare Part A
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicare Part B
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
POS
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
PPO
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Workers Comp
O
11263.11
1295.62
4337.63
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
EPO
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
HMO
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicaid
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicare Part A
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicare Part B
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
POS
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
PPO
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19084
null
cpt
Biopsy of breast accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Workers Comp
O
11263.11
1295.62
1295.62
6068.11
6757.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
EPO
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
HMO
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
Medicaid
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
Medicare Part A
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
Medicare Part B
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
POS
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
PPO
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19085
null
cpt
Biopsy of breast accessed through the skin with MRI guidance first lesion
blue cross blue shield
Workers Comp
O
9590.04
3800.12
3800.12
3800.12
5754.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
EPO
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
HMO
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
Medicaid
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
Medicare Part A
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
Medicare Part B
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
POS
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
PPO
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
aetna - medicare advantage
Workers Comp
I
16395.63
5584.74
5689.83
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
EPO
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
HMO
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
Medicaid
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
Medicare Part A
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
Medicare Part B
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
POS
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
PPO
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
blue cross blue shield
Workers Comp
I
16395.63
5584.74
6774.43
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
EPO
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
HMO
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
Medicaid
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
Medicare Part A
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
Medicare Part B
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
POS
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
PPO
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
humana - medicare advantage
Workers Comp
I
16395.63
5584.74
5584.74
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
EPO
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
HMO
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
Medicaid
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
Medicare Part A
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
Medicare Part B
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
POS
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
PPO
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
tricare
Workers Comp
I
16395.63
5584.74
6216.12
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
EPO
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
HMO
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
Medicaid
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
Medicare Part A
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
Medicare Part B
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
POS
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
PPO
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
191
null
ms-drg
chronic obstructive pulmonary disease with cc
va
Workers Comp
I
16395.63
5584.74
6438.09
6774.43
9837.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
EPO
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
HMO
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
Medicaid
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
Medicare Part A
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
Medicare Part B
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
POS
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
PPO
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
aetna
Workers Comp
O
15711.43
2683.82
11249.61
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
EPO
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
HMO
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
Medicaid
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
Medicare Part A
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
Medicare Part B
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
POS
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
PPO
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
blue cross blue shield - medicare advantage
Workers Comp
O
15711.43
2683.82
4565.74
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
EPO
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
HMO
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
Medicaid
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
Medicare Part A
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
Medicare Part B
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
POS
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
PPO
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19120
null
cpt
Removal of breast growth
tricare
Workers Comp
O
15711.43
2683.82
2683.82
11249.61
2684.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
EPO
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
HMO
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
Medicaid
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
Medicare Part A
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
Medicare Part B
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
POS
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
PPO
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19125
null
cpt
Removal of breast growth open procedure
tricare
Workers Comp
O
17852.84
2683.82
2683.82
2683.82
10711.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
EPO
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
HMO
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
Medicaid
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
Medicare Part A
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
Medicare Part B
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
POS
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
PPO
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
aetna - medicare advantage
Workers Comp
I
13652.22
4025.53
4644.61
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
POS
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
13652.22
4025.53
6150.25
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
EPO
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
HMO
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
Medicaid
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
Medicare Part A
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
Medicare Part B
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
POS
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
PPO
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
humana - medicare advantage
Workers Comp
I
13652.22
4025.53
4025.53
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
EPO
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
HMO
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
Medicaid
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
Medicare Part A
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
Medicare Part B
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
POS
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
PPO
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
192
null
ms-drg
chronic obstructive pulmonary disease without cc/mcc
va
Workers Comp
I
13652.22
4025.53
5257.22
6150.25
8191.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
EPO
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
HMO
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
Medicaid
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
Medicare Part A
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
Medicare Part B
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
POS
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
PPO
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
blue cross blue shield
Workers Comp
O
24797.05
2683.82
9653.94
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
EPO
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
HMO
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
Medicaid
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
Medicare Part A
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
Medicare Part B
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
POS
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
PPO
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
humana - medicare advantage
Workers Comp
O
24797.05
2683.82
4727.55
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
EPO
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
HMO
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
Medicaid
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
Medicare Part A
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
Medicare Part B
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
POS
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
PPO
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19281
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance first lesion
tricare
Workers Comp
O
24797.05
2683.82
2683.82
9653.94
14878.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
EPO
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
HMO
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
Medicaid
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
Medicare Part A
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
Medicare Part B
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
POS
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
PPO
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19282
null
cpt
Placement of breast localization devices accessed through the skin with mammographic guidance additional lesion
blue cross blue shield
Workers Comp
O
35310.85
13467.82
13467.82
13467.82
21186.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
EPO
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
HMO
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicaid
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicare Part A
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Medicare Part B
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
POS
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
PPO
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
blue cross blue shield
Workers Comp
O
29699.89
2556.12
12540.05
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
EPO
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
HMO
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicaid
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicare Part A
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Medicare Part B
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
POS
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
PPO
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
humana - medicare advantage
Workers Comp
O
29699.89
2556.12
4901.08
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
EPO
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
HMO
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
Medicaid
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
Medicare Part A
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
Medicare Part B
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
POS
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
PPO
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19285
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance first lesion
tricare
Workers Comp
O
29699.89
2556.12
2556.12
12540.05
17819.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
EPO
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
HMO
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicaid
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicare Part A
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Medicare Part B
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
POS
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
PPO
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
blue cross blue shield
Workers Comp
O
32412.57
4901.08
12724.51
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
EPO
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
HMO
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicaid
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicare Part A
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Medicare Part B
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
POS
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
PPO
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19286
null
cpt
Placement of breast localization devices accessed through the skin with ultrasound guidance additional lesion
humana - medicare advantage
Workers Comp
O
32412.57
4901.08
4901.08
12724.51
19447.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
EPO
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
HMO
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
Medicaid
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
Medicare Part A
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
Medicare Part B
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
POS
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
PPO
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19287
null
cpt
Placement of breast localization devices accessed through the skin with MRI guidance first lesion
tricare
Workers Comp
O
17707.57
4639.61
4639.61
4639.61
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
EPO
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
HMO
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
Medicaid
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
Medicare Part A
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
Medicare Part B
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
POS
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
PPO
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna
Workers Comp
I
29993.20
6293.35
19490.61
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
EPO
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
HMO
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
Medicaid
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
Medicare Part A
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
Medicare Part B
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
POS
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
PPO
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
aetna - medicare advantage
Workers Comp
I
29993.20
6293.35
8679.50
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
EPO
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
HMO
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
Medicaid
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
Medicare Part A
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
Medicare Part B
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
POS
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
PPO
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield
Workers Comp
I
29993.20
6293.35
15933.06
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
EPO
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
HMO
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
Medicaid
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
POS
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
PPO
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
29993.20
6293.35
13985.94
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
EPO
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
HMO
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
Medicaid
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
Medicare Part A
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
Medicare Part B
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
POS
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
PPO
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
humana - medicare advantage
Workers Comp
I
29993.20
6293.35
8192.41
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
EPO
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
HMO
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
Medicaid
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
Medicare Part A
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
Medicare Part B
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
POS
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
PPO
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
193
null
ms-drg
simple pneumonia and pleurisy with mcc
tricare
Workers Comp
I
29993.20
6293.35
6293.35
19490.61
17995.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
EPO
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
HMO
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
Medicaid
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
Medicare Part A
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
Medicare Part B
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
POS
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
PPO
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
tricare
Workers Comp
O
16590.82
2796.53
2796.62
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
EPO
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
HMO
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
Medicaid
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
Medicare Part A
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
Medicare Part B
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
POS
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
PPO
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19300
null
cpt
Removal of extra breast tissue
va
Workers Comp
O
16590.82
2796.53
2796.53
2796.62
9954.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
EPO
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
HMO
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
Medicaid
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
Medicare Part A
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
Medicare Part B
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
POS
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
PPO
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield
Workers Comp
O
22931.56
2683.82
11312.06
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
EPO
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
HMO
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
Medicaid
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
Medicare Part A
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
Medicare Part B
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
POS
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
PPO
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
blue cross blue shield - medicare advantage
Workers Comp
O
22931.56
2683.82
6987.63
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
EPO
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
HMO
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
Medicaid
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
Medicare Part A
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
Medicare Part B
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
POS
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
PPO
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
humana - medicare advantage
Workers Comp
O
22931.56
2683.82
4727.55
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
EPO
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
HMO
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
Medicaid
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
Medicare Part A
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
Medicare Part B
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
POS
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
PPO
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
tricare
Workers Comp
O
22931.56
2683.82
2683.82
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
EPO
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
HMO
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
Medicaid
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
Medicare Part A
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
Medicare Part B
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
POS
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
PPO
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
united healthcare
Workers Comp
O
22931.56
2683.82
12072.40
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
EPO
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
HMO
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
Medicaid
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
Medicare Part A
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
Medicare Part B
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
POS
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
PPO
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19301
null
cpt
Partial removal of breast
va
Workers Comp
O
22931.56
2683.82
2796.53
12072.40
13758.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
EPO
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
HMO
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
Medicaid
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
Medicare Part A
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
Medicare Part B
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
POS
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
PPO
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
blue cross blue shield
Workers Comp
O
24344.54
4547.22
9830.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
EPO
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
HMO
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
Medicaid
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
Medicare Part A
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
Medicare Part B
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
POS
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
PPO
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
humana - medicare advantage
Workers Comp
O
24344.54
4547.22
4770.35
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
EPO
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
HMO
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
Medicaid
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
Medicare Part A
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
Medicare Part B
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
POS
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
PPO
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
tricare
Workers Comp
O
24344.54
4547.22
4639.61
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
EPO
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
HMO
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
Medicaid
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
Medicare Part A
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
Medicare Part B
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
POS
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
PPO
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19303
null
cpt
Total removal of breast
united healthcare - medicare advantage
Workers Comp
O
24344.54
4547.22
4547.22
9830.35
14606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
EPO
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
HMO
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
Medicaid
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
Medicare Part A
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
Medicare Part B
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
POS
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
PPO
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
aetna
Workers Comp
O
23176.38
4552.66
10501.14
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
EPO
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
HMO
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
Medicaid
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
Medicare Part A
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
Medicare Part B
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
POS
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
PPO
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
blue cross blue shield - medicare advantage
Workers Comp
O
23176.38
4552.66
4552.66
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
EPO
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
HMO
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
Medicaid
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
Medicare Part A
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
Medicare Part B
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
POS
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
PPO
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19307
null
cpt
Removal of breast and underarm lymph nodes
humana - medicare advantage
Workers Comp
O
23176.38
4552.66
4639.61
10501.14
13905.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
EPO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
HMO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
Medicaid
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
Medicare Part A
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
Medicare Part B
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
POS
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
PPO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19340
null
cpt
Insertion of breast prosthesis at time of breast repositioning removal or reconstruction
blue cross blue shield - medicare advantage
Workers Comp
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
EPO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
HMO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
Medicaid
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
Medicare Part A
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
Medicare Part B
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
POS
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
PPO
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19371
null
cpt
Removal of capsule surrounding breast
blue cross blue shield - medicare advantage
Workers Comp
O
21279.32
5905.66
5905.66
5905.66
12767.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
EPO
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
HMO
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
Medicaid
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
Medicare Part A
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
Medicare Part B
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
POS
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
PPO
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna
Workers Comp
I
19757.78
4515.23
9778.82
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
EPO
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
HMO
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
Medicaid
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
Medicare Part A
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
Medicare Part B
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
POS
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
PPO
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
aetna - medicare advantage
Workers Comp
I
19757.78
4515.23
5703.94
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
EPO
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
HMO
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
Medicaid
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
Medicare Part A
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
Medicare Part B
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
POS
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
PPO
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield
Workers Comp
I
19757.78
4515.23
9428.53
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
EPO
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
HMO
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
Medicaid
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
POS
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
PPO
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
blue cross blue shield - medicare advantage
Workers Comp
I
19757.78
4515.23
7349.49
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
EPO
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
HMO
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
Medicaid
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
Medicare Part A
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
Medicare Part B
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
POS
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
PPO
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
humana - medicare advantage
Workers Comp
I
19757.78
4515.23
5500.27
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
EPO
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
HMO
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
Medicaid
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
Medicare Part A
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
Medicare Part B
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
POS
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
PPO
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
tricare
Workers Comp
I
19757.78
4515.23
4515.23
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
EPO
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
HMO
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
Medicaid
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
Medicare Part A
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
Medicare Part B
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
POS
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
PPO
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
194
null
ms-drg
simple pneumonia and pleurisy with cc
va
Workers Comp
I
19757.78
4515.23
6148.08
9778.82
11854.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
EPO
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
HMO
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
Medicaid
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
Medicare Part A
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
Medicare Part B
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
POS
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
PPO
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
blue cross blue shield
Workers Comp
O
28261.10
4726.90
13132.63
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
EPO
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
HMO
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
Medicaid
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
Medicare Part A
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
Medicare Part B
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
POS
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
PPO
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
19499
null
cpt
Breast procedure
humana - medicare advantage
Workers Comp
O
28261.10
4726.90
4726.90
13132.63
16956.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
EPO
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
HMO
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
Medicaid
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
Medicare Part A
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
Medicare Part B
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
POS
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
PPO
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield
Workers Comp
I
13915.99
3804.07
5975.94
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
POS
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
13915.99
3804.07
5097.47
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
EPO
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
HMO
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
Medicaid
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
Medicare Part A
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
Medicare Part B
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
POS
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
PPO
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
195
null
ms-drg
simple pneumonia and pleurisy without cc/mcc
humana - medicare advantage
Workers Comp
I
13915.99
3804.07
3804.07
5975.94
8349.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
EPO
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
HMO
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
Medicaid
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
POS
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
PPO
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
42204.38
10815.63
16052.47
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
EPO
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
HMO
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
Medicaid
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
Medicare Part A
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
Medicare Part B
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
POS
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
PPO
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
196
null
ms-drg
interstitial lung disease with mcc
humana - medicare advantage
Workers Comp
I
42204.38
10815.63
10815.63
16052.47
25322.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
EPO
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
HMO
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
Medicaid
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
Medicare Part A
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
Medicare Part B
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
POS
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
PPO
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
199
null
ms-drg
pneumothorax with mcc
va
Workers Comp
I
34256.98
11699.75
11699.75
11699.75
20554.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
EPO
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
HMO
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
Medicaid
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
Medicare Part A
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
Medicare Part B
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
POS
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
PPO
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
blue cross blue shield
Workers Comp
I
30542.21
5017.66
11937.38
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
EPO
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
HMO
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
Medicaid
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
Medicare Part A
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
Medicare Part B
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
POS
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
PPO
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
humana - medicare advantage
Workers Comp
I
30542.21
5017.66
6803.95
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
EPO
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
HMO
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
Medicaid
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
Medicare Part A
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
Medicare Part B
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
POS
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
PPO
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
tricare
Workers Comp
I
30542.21
5017.66
5017.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
EPO
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
HMO
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
Medicaid
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
Medicare Part A
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
Medicare Part B
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
POS
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
PPO
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
200
null
ms-drg
pneumothorax with cc
united healthcare
Workers Comp
I
30542.21
5017.66
22906.66
22906.66
18325.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
POS
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
201
null
ms-drg
pneumothorax without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
26423.95
6754.88
6754.88
6754.88
15854.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
EPO
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
HMO
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
POS
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
PPO
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
18022.63
3438.95
7278.11
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
EPO
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
HMO
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
Medicaid
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
Medicare Part A
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
Medicare Part B
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
POS
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
PPO
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
202
null
ms-drg
bronchitis and asthma with cc/mcc
tricare
Workers Comp
I
18022.63
3438.95
3438.95
7278.11
10813.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
EPO
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
HMO
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
Medicaid
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
Medicare Part A
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
Medicare Part B
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
POS
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
PPO
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20206
null
cpt
Needle biopsy of muscle accessed through the skin
blue cross blue shield - medicare advantage
Workers Comp
O
6364.61
1143.84
1143.84
1143.84
3818.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
EPO
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
HMO
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
Medicaid
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
Medicare Part A
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
Medicare Part B
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
POS
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
PPO
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
blue cross blue shield
Workers Comp
O
9140.16
1215.96
2162.80
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
EPO
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
HMO
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
Medicaid
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
Medicare Part A
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
Medicare Part B
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
POS
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
PPO
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20220
null
cpt
Biopsy of bone using needle or trocar
humana - medicare advantage
Workers Comp
O
9140.16
1215.96
1215.96
2162.80
5484.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
EPO
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
HMO
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
Medicaid
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
Medicare Part A
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
Medicare Part B
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
POS
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
PPO
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
humana - medicare advantage
Workers Comp
I
11649.39
3143.82
3143.82
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
EPO
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
HMO
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
Medicaid
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
Medicare Part A
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
Medicare Part B
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
POS
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
PPO
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
203
null
ms-drg
bronchitis and asthma without cc/mcc
tricare
Workers Comp
I
11649.39
3143.82
3230.80
3230.80
6989.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
EPO
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
HMO
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
Medicaid
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
Medicare Part A
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
Medicare Part B
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
POS
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
PPO
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20550
null
cpt
Injections of tendon sheath ligament or muscle membrane
blue cross blue shield
Workers Comp
O
591.42
269.22
269.22
269.22
354.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
EPO
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
HMO
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
Medicaid
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
Medicare Part A
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
Medicare Part B
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
POS
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
PPO
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20551
null
cpt
Injections of tendon attachment to bone
blue cross blue shield
Workers Comp
O
534.87
16365.34
16365.34
16365.34
320.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
EPO
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
HMO
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
Medicaid
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
Medicare Part A
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
Medicare Part B
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
POS
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
PPO
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
206
null
ms-drg
other respiratory system diagnoses without mcc
va
Workers Comp
I
28737.41
5911.07
5911.07
5911.07
17242.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
EPO
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
HMO
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
Medicaid
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
Medicare Part A
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
Medicare Part B
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
POS
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
PPO
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
aetna - medicare advantage
Workers Comp
O
627.51
225.41
289.57
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
EPO
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
HMO
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
Medicaid
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
Medicare Part A
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
Medicare Part B
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
POS
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
PPO
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield
Workers Comp
O
627.51
225.41
1031.80
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
EPO
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
HMO
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
Medicaid
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
Medicare Part A
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
Medicare Part B
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
POS
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
PPO
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
blue cross blue shield - medicare advantage
Workers Comp
O
627.51
225.41
881.69
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
EPO
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
HMO
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
Medicaid
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
Medicare Part A
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
Medicare Part B
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
POS
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
PPO
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
humana - medicare advantage
Workers Comp
O
627.51
225.41
335.53
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
EPO
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
HMO
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
Medicaid
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
Medicare Part A
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
Medicare Part B
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
POS
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
PPO
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
tricare
Workers Comp
O
627.51
225.41
231.90
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
EPO
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
HMO
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
Medicaid
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
Medicare Part A
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
Medicare Part B
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
POS
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
PPO
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20610
null
cpt
Aspiration and/or injection of large joint or joint capsule
va
Workers Comp
O
627.51
225.41
225.41
1031.80
376.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
EPO
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
HMO
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
Medicaid
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
Medicare Part A
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
Medicare Part B
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
POS
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
PPO
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
aetna
Workers Comp
O
1235.27
211.29
211.29
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
EPO
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
HMO
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
Medicaid
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
Medicare Part A
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
Medicare Part B
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
POS
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
PPO
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
blue cross blue shield
Workers Comp
O
1235.27
211.29
1560.40
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
EPO
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
HMO
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
Medicaid
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
Medicare Part A
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
Medicare Part B
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
POS
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
PPO
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20611
null
cpt
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance
va
Workers Comp
O
1235.27
211.29
230.44
1560.40
741.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
EPO
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
HMO
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
Medicaid
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
Medicare Part A
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
Medicare Part B
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
POS
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
PPO
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20615
null
cpt
Aspiration and injection treatment of bone cyst
blue cross blue shield - medicare advantage
Workers Comp
O
1290.38
1290.38
1290.38
1290.38
774.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
EPO
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
HMO
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
Medicaid
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
Medicare Part A
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
Medicare Part B
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
POS
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
PPO
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
blue cross blue shield
Workers Comp
O
19601.34
2076.62
5259.68
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
EPO
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
HMO
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
Medicaid
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
Medicare Part A
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
Medicare Part B
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
POS
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
PPO
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20680
null
cpt
Removal of deep bone implant
tricare
Workers Comp
O
19601.34
2076.62
2076.62
5259.68
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
EPO
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
HMO
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
Medicaid
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
Medicare Part A
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
Medicare Part B
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
POS
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
PPO
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield
Workers Comp
I
163759.52
34367.09
62050.63
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
EPO
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
HMO
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
Medicaid
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
Medicare Part A
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
Medicare Part B
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
POS
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
PPO
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
blue cross blue shield - medicare advantage
Workers Comp
I
163759.52
34367.09
46168.52
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
EPO
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
HMO
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
Medicaid
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
Medicare Part A
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
Medicare Part B
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
POS
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
PPO
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
humana - medicare advantage
Workers Comp
I
163759.52
34367.09
34367.09
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
EPO
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
HMO
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
Medicaid
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
Medicare Part A
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
Medicare Part B
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
POS
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
PPO
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
united healthcare
Workers Comp
I
163759.52
34367.09
173837.62
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
EPO
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
HMO
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
Medicaid
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
Medicare Part A
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
Medicare Part B
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
POS
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
PPO
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
va
Workers Comp
I
163759.52
34367.09
40488.89
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
EPO
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
HMO
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
Medicaid
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
Medicare Part A
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
Medicare Part B
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
POS
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
PPO
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
207
null
ms-drg
respiratory system diagnosis with ventilator support >96 hours
webtpa
Workers Comp
I
163759.52
34367.09
85116.00
173837.62
98255.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
EPO
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
HMO
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
Medicaid
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
Medicare Part A
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
Medicare Part B
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
POS
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
PPO
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield
Workers Comp
I
64411.44
15147.62
26637.75
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
EPO
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
HMO
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
Medicaid
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
Medicare Part A
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
Medicare Part B
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
POS
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
PPO
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
blue cross blue shield - medicare advantage
Workers Comp
I
64411.44
15147.62
19689.44
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
EPO
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
HMO
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
Medicaid
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
Medicare Part A
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
Medicare Part B
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
POS
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
PPO
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
humana - medicare advantage
Workers Comp
I
64411.44
15147.62
15147.62
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
EPO
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
HMO
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
Medicaid
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
Medicare Part A
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
Medicare Part B
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
POS
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
PPO
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
tricare
Workers Comp
I
64411.44
15147.62
15925.66
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
EPO
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
HMO
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
Medicaid
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
Medicare Part A
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
Medicare Part B
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
POS
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
PPO
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
208
null
ms-drg
respiratory system diagnosis with ventilator support <=96 hours
va
Workers Comp
I
64411.44
15147.62
27243.57
27243.57
38646.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
EPO
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
HMO
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
Medicaid
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
Medicare Part A
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
Medicare Part B
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
POS
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
PPO
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
blue cross blue shield
Workers Comp
O
88266.62
10542.60
12883.32
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
EPO
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
HMO
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
Medicaid
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
Medicare Part A
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
Medicare Part B
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
POS
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
PPO
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20900
null
cpt
Small bone graft harvest
tricare
Workers Comp
O
88266.62
10542.60
10542.60
12883.32
52959.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
EPO
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
HMO
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
Medicaid
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
Medicare Part A
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
Medicare Part B
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
POS
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
PPO
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
blue cross blue shield
Workers Comp
O
64169.40
10542.60
10951.97
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
EPO
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
HMO
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
Medicaid
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
Medicare Part A
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
Medicare Part B
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
POS
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
PPO
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
humana - medicare advantage
Workers Comp
O
64169.40
10542.60
10788.16
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
EPO
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
HMO
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
Medicaid
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
Medicare Part A
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
Medicare Part B
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
POS
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
PPO
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
tricare
Workers Comp
O
64169.40
10542.60
10542.60
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
EPO
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
HMO
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
Medicaid
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
Medicare Part A
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
Medicare Part B
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
POS
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
PPO
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20930
null
cpt
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery
va
Workers Comp
O
64169.40
10542.60
11002.05
11002.05
38501.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
EPO
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
HMO
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
Medicaid
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
Medicare Part A
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
Medicare Part B
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
POS
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
PPO
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
blue cross blue shield
Workers Comp
O
86401.17
10625.21
12105.41
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
EPO
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
HMO
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
Medicaid
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
Medicare Part A
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
Medicare Part B
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
POS
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
PPO
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
humana - medicare advantage
Workers Comp
O
86401.17
10625.21
11002.42
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
EPO
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
HMO
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
Medicaid
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
Medicare Part A
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
Medicare Part B
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
POS
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
PPO
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20931
null
cpt
Structural donor bone graft for spine surgery
tricare
Workers Comp
O
86401.17
10625.21
10625.21
12105.41
51840.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
EPO
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
HMO
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
Medicaid
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
Medicare Part A
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
Medicare Part B
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
POS
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
PPO
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
humana - medicare advantage
Workers Comp
O
72166.92
10542.60
10788.16
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
EPO
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
HMO
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
Medicaid
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
Medicare Part A
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
Medicare Part B
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
POS
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
PPO
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
tricare
Workers Comp
O
72166.92
10542.60
10542.60
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
EPO
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
HMO
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
Medicaid
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
Medicare Part A
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
Medicare Part B
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
POS
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
PPO
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20936
null
cpt
Harvest of bone from same spine incision for graft
va
Workers Comp
O
72166.92
10542.60
11002.05
11002.05
43300.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
EPO
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
HMO
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
Medicaid
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
POS
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
PPO
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
20999
null
cpt
Muscle and bone procedure
blue cross blue shield - medicare advantage
Workers Comp
O
19601.34
6579.79
6579.79
6579.79
11760.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
EPO
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
HMO
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
Medicaid
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
Medicare Part A
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
Medicare Part B
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
POS
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
PPO
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
aetna
Workers Comp
O
14672.23
2320.38
8791.43
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
EPO
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
HMO
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
Medicaid
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
Medicare Part A
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
Medicare Part B
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
POS
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
PPO
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
humana - medicare advantage
Workers Comp
O
14672.23
2320.38
2320.38
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
EPO
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
HMO
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
Medicaid
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
Medicare Part A
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
Medicare Part B
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
POS
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
PPO
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21320
null
cpt
Closed treatment of broken nasal bone with stabilization
tricare
Workers Comp
O
14672.23
2320.38
2371.92
8791.43
8803.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
EPO
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
HMO
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
Medicaid
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
Medicare Part A
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
Medicare Part B
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
POS
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
PPO
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
blue cross blue shield
Workers Comp
I
166433.72
75434.18
123229.58
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
EPO
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
HMO
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
Medicaid
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
Medicare Part A
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
Medicare Part B
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
POS
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
PPO
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
215
null
ms-drg
other heart assist system implant
humana - medicare advantage
Workers Comp
I
166433.72
75434.18
75434.18
123229.58
99860.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
EPO
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
HMO
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
Medicaid
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
Medicare Part A
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
Medicare Part B
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
POS
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
PPO
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21552
null
cpt
Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest
va
Workers Comp
O
12702.39
2098.90
2098.90
2098.90
7621.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
EPO
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
HMO
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
Medicaid
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
Medicare Part A
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
Medicare Part B
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
POS
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
PPO
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21555
null
cpt
Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest
tricare
Workers Comp
O
16785.66
1246.10
1246.10
1246.10
10071.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
EPO
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
HMO
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
Medicaid
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
Medicare Part A
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
Medicare Part B
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
POS
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
PPO
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
217
null
ms-drg
cardiac valve and other major cardiothoracic procedures with cardiac catheterization with cc
humana - medicare advantage
Workers Comp
I
252168.16
41229.21
41229.21
41229.21
151300.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
EPO
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
HMO
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
Medicaid
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
Medicare Part A
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
Medicare Part B
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
POS
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
PPO
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
219
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with mcc
aetna
Workers Comp
I
252517.54
46497.02
46497.02
46497.02
151510.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
EPO
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
HMO
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
Medicaid
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
Medicare Part A
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
Medicare Part B
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
POS
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
PPO
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
blue cross blue shield
Workers Comp
O
16748.88
971.10
4649.59
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
EPO
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
HMO
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
Medicaid
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
Medicare Part A
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
Medicare Part B
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
POS
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
PPO
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
humana - medicare advantage
Workers Comp
O
16748.88
971.10
971.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
EPO
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
HMO
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
Medicaid
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
Medicare Part A
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
Medicare Part B
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
POS
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
PPO
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
tricare
Workers Comp
O
16748.88
971.10
1246.10
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
EPO
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
HMO
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
Medicaid
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
Medicare Part A
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
Medicare Part B
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
POS
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
PPO
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
21931
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank
va
Workers Comp
O
16748.88
971.10
2098.90
4649.59
10049.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
EPO
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
HMO
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
Medicaid
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
Medicare Part A
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
Medicare Part B
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
POS
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
PPO
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield
Workers Comp
I
166446.71
30407.08
54699.55
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
EPO
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
HMO
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
Medicaid
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
POS
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
PPO
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
blue cross blue shield - medicare advantage
Workers Comp
I
166446.71
30407.08
48014.93
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
EPO
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
HMO
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
Medicaid
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
Medicare Part A
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
Medicare Part B
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
POS
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
PPO
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
humana - medicare advantage
Workers Comp
I
166446.71
30407.08
30407.08
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
EPO
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
HMO
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
Medicaid
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
Medicare Part A
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
Medicare Part B
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
POS
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
PPO
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
tricare
Workers Comp
I
166446.71
30407.08
34634.34
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
EPO
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
HMO
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
Medicaid
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
Medicare Part A
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
Medicare Part B
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
POS
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
PPO
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
220
null
ms-drg
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc
webtpa
Workers Comp
I
166446.71
30407.08
46942.95
54699.55
99868.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
EPO
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
HMO
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
Medicaid
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
Medicare Part A
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
Medicare Part B
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
POS
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
PPO
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22513
null
cpt
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending
humana - medicare advantage
Workers Comp
O
38084.68
10542.60
10542.60
10542.60
22850.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
EPO
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
HMO
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicaid
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicare Part A
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicare Part B
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
POS
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
PPO
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22514
null
cpt
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Workers Comp
O
32113.91
5093.22
5093.22
5093.22
19268.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
EPO
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
HMO
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicaid
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicare Part A
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Medicare Part B
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
POS
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
PPO
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22515
null
cpt
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance
humana - medicare advantage
Workers Comp
O
54242.39
10542.60
10542.60
10542.60
32545.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
EPO
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
HMO
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
Medicaid
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
Medicare Part A
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
Medicare Part B
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
POS
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
PPO
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22551
null
cpt
Fusion of spine bones with removal of disc at upper spinal column anterior approach complex
tricare
Workers Comp
O
48750.63
10542.60
10542.60
10542.60
29250.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
EPO
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
HMO
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
Medicaid
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
Medicare Part A
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
Medicare Part B
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
POS
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
PPO
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
blue cross blue shield
Workers Comp
O
61755.68
10542.60
10849.22
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
EPO
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
HMO
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
Medicaid
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
Medicare Part A
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
Medicare Part B
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
POS
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
PPO
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22552
null
cpt
Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck  anterior approach
tricare
Workers Comp
O
61755.68
10542.60
10542.60
10849.22
37053.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
EPO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
HMO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
Medicaid
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
Medicare Part A
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
Medicare Part B
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
POS
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
PPO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22585
null
cpt
Fusion of spine bones with removal of disc anterior approach
blue cross blue shield - medicare advantage
Workers Comp
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
EPO
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
HMO
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
Medicaid
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
Medicare Part A
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
Medicare Part B
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
POS
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
PPO
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
226
null
ms-drg
cardiac defibrillator implant without cardiac catheterization with mcc
va
Workers Comp
I
104622.07
39399.28
39399.28
39399.28
62773.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
EPO
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
HMO
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
Medicaid
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
Medicare Part A
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
Medicare Part B
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
POS
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
PPO
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
humana - medicare advantage
Workers Comp
O
89607.10
10542.60
10788.16
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
EPO
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
HMO
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
Medicaid
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
Medicare Part A
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
Medicare Part B
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
POS
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
PPO
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
tricare
Workers Comp
O
89607.10
10542.60
10542.60
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
EPO
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
HMO
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
Medicaid
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
Medicare Part A
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
Medicare Part B
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
POS
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
PPO
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22612
null
cpt
Fusion of lower spine bones posterior or posterolateral approach
va
Workers Comp
O
89607.10
10542.60
11002.05
11002.05
53764.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
EPO
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
HMO
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
Medicaid
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
Medicare Part A
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
Medicare Part B
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
POS
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
PPO
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
blue cross blue shield
Workers Comp
O
89428.23
6298.42
6298.42
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
EPO
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
HMO
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
Medicaid
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
Medicare Part A
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
Medicare Part B
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
POS
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
PPO
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
humana - medicare advantage
Workers Comp
O
89428.23
6298.42
10573.89
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
EPO
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
HMO
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
Medicaid
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
Medicare Part A
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
Medicare Part B
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
POS
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
PPO
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
tricare
Workers Comp
O
89428.23
6298.42
10542.60
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
EPO
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
HMO
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
Medicaid
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
Medicare Part A
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
Medicare Part B
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
POS
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
PPO
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22614
null
cpt
Fusion of spine bones posterior or posterolateral approach
va
Workers Comp
O
89428.23
6298.42
11002.05
11002.05
53656.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
EPO
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
HMO
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
Medicaid
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
Medicare Part A
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
Medicare Part B
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
POS
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
PPO
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
blue cross blue shield
Workers Comp
O
89891.56
9590.87
9590.87
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
EPO
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
HMO
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
Medicaid
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
Medicare Part A
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
Medicare Part B
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
POS
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
PPO
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
humana - medicare advantage
Workers Comp
O
89891.56
9590.87
10788.16
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
EPO
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
HMO
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
Medicaid
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
Medicare Part A
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
Medicare Part B
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
POS
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
PPO
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22840
null
cpt
Insertion of posterior spinal instrumentation at base of neck for stabilization 1 interspace
tricare
Workers Comp
O
89891.56
9590.87
10542.60
10788.16
53934.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
EPO
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
HMO
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
Medicaid
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
Medicare Part A
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
Medicare Part B
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
POS
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
PPO
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield
Workers Comp
O
49703.27
9449.91
10276.07
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
EPO
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
HMO
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
Medicaid
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
Medicare Part A
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
Medicare Part B
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
POS
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
PPO
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
blue cross blue shield - medicare advantage
Workers Comp
O
49703.27
9449.91
9449.91
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
EPO
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
HMO
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
Medicaid
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
Medicare Part A
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
Medicare Part B
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
POS
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
PPO
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22845
null
cpt
Insertion of anterior spinal instrumentation for spinal stabilization 2 to 3 vertebral segments
tricare
Workers Comp
O
49703.27
9449.91
10542.60
10542.60
29821.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
EPO
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
HMO
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
Medicaid
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
Medicare Part A
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
Medicare Part B
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
POS
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
PPO
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22853
null
cpt
Insertion of device into intervertebral disc space of spine and fusion of vertebrae
tricare
Workers Comp
O
49002.51
10724.52
10724.52
10724.52
29401.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
EPO
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
HMO
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
Medicaid
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
Medicare Part A
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
Medicare Part B
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
POS
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
PPO
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22856
null
cpt
Insertion of artificial upper spine disc anterior approach
tricare
Workers Comp
O
56504.97
14208.92
14208.92
14208.92
33902.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
EPO
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
HMO
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicaid
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicare Part A
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicare Part B
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
POS
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
PPO
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22902
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Workers Comp
O
14014.45
3796.56
3796.56
3796.56
8408.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
EPO
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
HMO
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicaid
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicare Part A
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Medicare Part B
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
POS
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
PPO
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
blue cross blue shield
Workers Comp
O
15816.22
2098.98
3991.84
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
EPO
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
HMO
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
Medicaid
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
Medicare Part A
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
Medicare Part B
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
POS
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
PPO
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22903
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall
tricare
Workers Comp
O
15816.22
2098.98
2098.98
3991.84
9489.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
EPO
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
HMO
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
Medicaid
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
Medicare Part A
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
Medicare Part B
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
POS
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
PPO
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
22999
null
cpt
Procedure on abdomen muscle or bone
blue cross blue shield
Workers Comp
O
31114.14
8063.39
8063.39
8063.39
18668.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
EPO
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
HMO
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
Medicaid
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
Medicare Part A
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
Medicare Part B
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
POS
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
PPO
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23020
null
cpt
Severing of shoulder tendon to repair contracture
blue cross blue shield
Workers Comp
O
12198.14
8259.05
8259.05
8259.05
7318.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
EPO
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
HMO
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
Medicaid
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
Medicare Part A
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
Medicare Part B
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
POS
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
PPO
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield
Workers Comp
O
15457.29
1246.10
5134.95
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
EPO
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
HMO
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
Medicaid
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
Medicare Part A
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
Medicare Part B
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
POS
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
PPO
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
blue cross blue shield - medicare advantage
Workers Comp
O
15457.29
1246.10
1933.13
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
EPO
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
HMO
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
Medicaid
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
Medicare Part A
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
Medicare Part B
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
POS
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
PPO
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area
tricare
Workers Comp
O
15457.29
1246.10
1246.10
5134.95
9274.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
EPO
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
HMO
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
Medicaid
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
Medicare Part A
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
Medicare Part B
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
POS
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
PPO
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23073
null
cpt
Removal (5 centimeters or greater) muscle growth of shoulder area
humana - medicare advantage
Workers Comp
O
16676.91
2098.98
2098.98
2098.98
10006.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
EPO
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
HMO
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
Medicaid
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
Medicare Part A
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
Medicare Part B
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
POS
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
PPO
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area
tricare
Workers Comp
O
15384.08
1246.10
1246.10
1246.10
9230.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
EPO
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
HMO
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
Medicaid
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
Medicare Part A
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
Medicare Part B
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
POS
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
PPO
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23120
null
cpt
Partial removal of collar bone
tricare
Workers Comp
O
38200.34
5299.29
5299.29
5299.29
22920.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
EPO
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
HMO
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
Medicaid
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
Medicare Part A
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
Medicare Part B
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
POS
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
PPO
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23130
null
cpt
Removal or repair of collar bone and shoulder blade joint
va
Workers Comp
O
39402.70
5407.15
5407.15
5407.15
23641.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
EPO
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
HMO
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
Medicaid
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
Medicare Part A
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
Medicare Part B
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
POS
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
PPO
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
humana - medicare advantage
Workers Comp
I
186007.21
33341.41
33341.41
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
EPO
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
HMO
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
Medicaid
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
Medicare Part A
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
Medicare Part B
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
POS
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
PPO
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
tricare
Workers Comp
I
186007.21
33341.41
40869.47
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
EPO
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
HMO
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
Medicaid
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
Medicare Part A
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
Medicare Part B
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
POS
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
PPO
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
232
null
ms-drg
coronary bypass with ptca without mcc
webtpa
Workers Comp
I
186007.21
33341.41
85563.29
85563.29
111604.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
EPO
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
HMO
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
Medicaid
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
Medicare Part A
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
Medicare Part B
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
POS
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
PPO
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
humana - medicare advantage
Workers Comp
I
319883.29
45500.18
45500.18
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
EPO
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
HMO
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
Medicaid
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
Medicare Part A
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
Medicare Part B
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
POS
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
PPO
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
233
null
ms-drg
coronary bypass with cardiac catheterization with mcc
united healthcare
Workers Comp
I
319883.29
45500.18
141718.36
141718.36
191929.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
EPO
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
HMO
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
Medicaid
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
Medicare Part A
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
Medicare Part B
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
POS
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
PPO
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield
Workers Comp
O
4664.97
693.80
1144.61
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
EPO
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
HMO
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
Medicaid
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
Medicare Part A
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
Medicare Part B
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
POS
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
PPO
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
blue cross blue shield - medicare advantage
Workers Comp
O
4664.97
693.80
693.80
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
EPO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
HMO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
Medicaid
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
Medicare Part A
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
Medicare Part B
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
POS
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
PPO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
humana - medicare advantage
Workers Comp
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
EPO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
HMO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
Medicaid
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
Medicare Part A
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
Medicare Part B
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
POS
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
PPO
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
tricare
Workers Comp
O
4664.97
693.80
941.39
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
EPO
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
HMO
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
Medicaid
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
Medicare Part A
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
Medicare Part B
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
POS
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
PPO
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23350
null
cpt
Injection of dye for X-ray imaging of shoulder joint
va
Workers Comp
O
4664.97
693.80
717.95
1144.61
2798.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
EPO
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
HMO
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
Medicaid
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
Medicare Part A
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
Medicare Part B
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
POS
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
PPO
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield
Workers Comp
I
171423.09
29454.20
57597.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
EPO
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
HMO
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
Medicaid
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
POS
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
PPO
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
171423.09
29454.20
40385.49
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
EPO
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
HMO
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
Medicaid
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
Medicare Part A
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
Medicare Part B
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
POS
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
PPO
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
humana - medicare advantage
Workers Comp
I
171423.09
29454.20
29454.20
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
EPO
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
HMO
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
Medicaid
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
Medicare Part A
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
Medicare Part B
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
POS
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
PPO
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
tricare
Workers Comp
I
171423.09
29454.20
36449.33
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
EPO
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
HMO
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
Medicaid
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
Medicare Part A
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
Medicare Part B
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
POS
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
PPO
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
234
null
ms-drg
coronary bypass with cardiac catheterization without mcc
united healthcare
Workers Comp
I
171423.09
29454.20
112527.02
112527.02
102853.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
EPO
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
HMO
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
Medicaid
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
Medicare Part A
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
Medicare Part B
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
POS
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
PPO
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield
Workers Comp
O
36231.48
4460.63
13722.97
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
EPO
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
HMO
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
Medicaid
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
Medicare Part A
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
Medicare Part B
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
POS
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
PPO
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
blue cross blue shield - medicare advantage
Workers Comp
O
36231.48
4460.63
4460.63
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
EPO
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
HMO
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
Medicaid
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
Medicare Part A
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
Medicare Part B
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
POS
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
PPO
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23412
null
cpt
Repair of torn tendons of shoulder (rotator cuff) open procedure chronic or old
va
Workers Comp
O
36231.48
4460.63
5407.15
13722.97
21738.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
EPO
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
HMO
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
Medicaid
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
Medicare Part A
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
Medicare Part B
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
POS
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
PPO
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23430
null
cpt
Anchoring of biceps tendon
va
Workers Comp
O
51540.67
5407.15
5407.15
5407.15
30924.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
EPO
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
HMO
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
Medicaid
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
Medicare Part A
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
Medicare Part B
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
POS
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
PPO
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
tricare
Workers Comp
O
35247.55
5548.30
5548.49
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
EPO
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
HMO
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
Medicaid
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
Medicare Part A
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
Medicare Part B
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
POS
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
PPO
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23455
null
cpt
Reattachment of shoulder joint capsule and cartilage without bone transfer with repair of shoulder rim
va
Workers Comp
O
35247.55
5548.30
5548.30
5548.49
21148.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
EPO
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
HMO
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
Medicaid
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
Medicare Part A
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
Medicare Part B
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
POS
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
PPO
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
aetna - medicare advantage
Workers Comp
I
123346.27
15725.84
15725.84
15725.84
74007.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
EPO
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
HMO
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
Medicaid
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
Medicare Part A
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
Medicare Part B
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
POS
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
PPO
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield
Workers Comp
O
72953.52
10906.07
21725.54
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
EPO
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
HMO
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
Medicaid
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
Medicare Part A
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
Medicare Part B
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
POS
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
PPO
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
blue cross blue shield - medicare advantage
Workers Comp
O
72953.52
10906.07
18740.98
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
EPO
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
HMO
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
Medicaid
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
Medicare Part A
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
Medicare Part B
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
POS
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
PPO
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
humana - medicare advantage
Workers Comp
O
72953.52
10906.07
10906.44
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
EPO
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
HMO
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
Medicaid
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
Medicare Part A
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
Medicare Part B
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
POS
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
PPO
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23472
null
cpt
Prosthetic repair of shoulder joint total shoulder
va
Workers Comp
O
72953.52
10906.07
10906.07
21725.54
43772.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
EPO
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
HMO
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
Medicaid
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
Medicare Part A
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
Medicare Part B
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
POS
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
PPO
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23485
null
cpt
Incision to repair collar bone for nonunion of fracture with bone graft
tricare
Workers Comp
O
50364.07
10906.44
10906.44
10906.44
30218.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
EPO
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
HMO
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
Medicaid
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
Medicare Part A
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
Medicare Part B
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
POS
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
PPO
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
humana - medicare advantage
Workers Comp
I
164965.37
27732.06
34881.01
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
EPO
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
HMO
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
Medicaid
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
Medicare Part A
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
Medicare Part B
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
POS
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
PPO
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
235
null
ms-drg
coronary bypass without cardiac catheterization with mcc
va
Workers Comp
I
164965.37
27732.06
27732.06
34881.01
98979.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
EPO
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
HMO
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
Medicaid
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
Medicare Part A
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
Medicare Part B
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
POS
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
PPO
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
cigna
Workers Comp
O
32825.20
5423.89
24369.44
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
EPO
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
HMO
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
Medicaid
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
Medicare Part A
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
Medicare Part B
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
POS
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
PPO
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23515
null
cpt
Open treatment of collar bone broken
tricare
Workers Comp
O
32825.20
5423.89
5423.89
24369.44
19695.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
EPO
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
HMO
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
Medicaid
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
Medicare Part A
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
Medicare Part B
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
POS
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
PPO
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
humana - medicare advantage
Workers Comp
O
40553.56
5299.29
5548.49
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
EPO
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
HMO
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
Medicaid
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
Medicare Part A
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
Medicare Part B
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
POS
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
PPO
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23550
null
cpt
Open treatment of collar bone and shoulder joint dislocation
tricare
Workers Comp
O
40553.56
5299.29
5299.29
5548.49
24332.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
EPO
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
HMO
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
Medicaid
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
Medicare Part A
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
Medicare Part B
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
POS
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
PPO
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
236
null
ms-drg
coronary bypass without cardiac catheterization without mcc
humana - medicare advantage
Workers Comp
I
108445.64
23866.31
23866.31
23866.31
65067.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
EPO
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
HMO
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
Medicaid
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
Medicare Part A
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
Medicare Part B
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
POS
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
PPO
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
239
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with mcc
humana - medicare advantage
Workers Comp
I
70888.35
21734.48
21734.48
21734.48
42533.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
EPO
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
HMO
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
Medicaid
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
Medicare Part A
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
Medicare Part B
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
POS
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
PPO
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
tricare
Workers Comp
O
30814.56
2425.05
2425.05
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
EPO
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
HMO
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
Medicaid
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
Medicare Part A
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
Medicare Part B
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
POS
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
PPO
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
23929
null
cpt
Shoulder procedure
va
Workers Comp
O
30814.56
2425.05
5407.15
5407.15
18488.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
EPO
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
HMO
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
Medicaid
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
Medicare Part A
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
Medicare Part B
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
POS
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
PPO
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
humana - medicare advantage
Workers Comp
I
59383.58
10627.47
10627.47
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
EPO
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
HMO
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
Medicaid
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
Medicare Part A
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
Medicare Part B
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
POS
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
PPO
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
240
null
ms-drg
amputation for circulatory system disorders except upper limb and toe with cc
tricare
Workers Comp
I
59383.58
10627.47
19723.51
19723.51
35630.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
EPO
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
HMO
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
Medicaid
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
Medicare Part A
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
Medicare Part B
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
POS
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
PPO
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24071
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow
blue cross blue shield - medicare advantage
Workers Comp
O
16097.39
2294.00
2294.00
2294.00
9658.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
EPO
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
HMO
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
Medicaid
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
Medicare Part A
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
Medicare Part B
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
POS
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
PPO
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
241
null
ms-drg
amputation for circulatory system disorders except upper limb and toe without cc/mcc
humana - medicare advantage
Workers Comp
I
28861.80
9329.79
9329.79
9329.79
17317.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
EPO
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
HMO
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
Medicaid
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
POS
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
PPO
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
blue cross blue shield - medicare advantage
Workers Comp
I
56617.51
14811.97
20821.91
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
EPO
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
HMO
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
Medicaid
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
Medicare Part A
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
Medicare Part B
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
POS
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
PPO
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
243
null
ms-drg
permanent cardiac pacemaker implant with cc
humana - medicare advantage
Workers Comp
I
56617.51
14811.97
14811.97
20821.91
33970.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
EPO
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
HMO
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
Medicaid
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
Medicare Part A
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
Medicare Part B
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
POS
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
PPO
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24300
null
cpt
Manipulation of elbow under anesthesia
tricare
Workers Comp
O
17571.18
1200.71
1200.71
1200.71
10542.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
EPO
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
HMO
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
Medicaid
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
Medicare Part A
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
Medicare Part B
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
POS
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
PPO
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
blue cross blue shield
Workers Comp
O
30929.05
5299.29
8581.42
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
EPO
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
HMO
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
Medicaid
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
Medicare Part A
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
Medicare Part B
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
POS
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
PPO
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24341
null
cpt
Repair of tendon or muscle of upper arm or elbow
tricare
Workers Comp
O
30929.05
5299.29
5299.29
8581.42
18557.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
EPO
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
HMO
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
Medicaid
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
Medicare Part A
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
Medicare Part B
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
POS
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
PPO
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24342
null
cpt
Reinsertion of torn biceps or triceps tendon at elbow
tricare
Workers Comp
O
25281.09
5299.29
5299.29
5299.29
15168.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
EPO
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
HMO
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
Medicaid
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
Medicare Part A
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
Medicare Part B
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
POS
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
PPO
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24344
null
cpt
Repair of ligament on the outside of the elbow with a tendon graft
tricare
Workers Comp
O
49166.09
5548.49
5548.49
5548.49
29499.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
EPO
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
HMO
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
Medicaid
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
Medicare Part A
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
Medicare Part B
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
POS
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
PPO
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24515
null
cpt
Open treatment of broken upper arm bone mid-portion
tricare
Workers Comp
O
38134.26
10542.60
10542.60
10542.60
22880.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
EPO
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
HMO
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
Medicaid
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
Medicare Part A
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
Medicare Part B
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
POS
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
PPO
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24516
null
cpt
Treatment of broken upper arm bone
humana - medicare advantage
Workers Comp
O
51406.14
10906.44
10906.44
10906.44
30843.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
EPO
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
HMO
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
Medicaid
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
Medicare Part A
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
Medicare Part B
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
POS
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
PPO
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24579
null
cpt
Open treatment of broken upper arm bone at shoulder
blue cross blue shield
Workers Comp
O
58820.03
10775.88
10775.88
10775.88
35292.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
EPO
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
HMO
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
Medicaid
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
Medicare Part A
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
Medicare Part B
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
POS
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
PPO
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
aetna - medicare advantage
Workers Comp
I
96687.06
18996.78
19156.60
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
EPO
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
HMO
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
Medicaid
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
Medicare Part A
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
Medicare Part B
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
POS
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
PPO
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield
Workers Comp
I
96687.06
18996.78
30700.10
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
EPO
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
HMO
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
Medicaid
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
Medicare Part A
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
Medicare Part B
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
POS
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
PPO
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
blue cross blue shield - medicare advantage
Workers Comp
I
96687.06
18996.78
36115.88
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
EPO
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
HMO
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
Medicaid
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
Medicare Part A
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
Medicare Part B
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
POS
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
PPO
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
humana - medicare advantage
Workers Comp
I
96687.06
18996.78
19025.98
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
EPO
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
HMO
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
Medicaid
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
Medicare Part A
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
Medicare Part B
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
POS
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
PPO
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
tricare
Workers Comp
I
96687.06
18996.78
27110.06
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
EPO
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
HMO
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
Medicaid
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
Medicare Part A
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
Medicare Part B
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
POS
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
PPO
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
united healthcare
Workers Comp
I
96687.06
18996.78
48586.64
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
EPO
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
HMO
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
Medicaid
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
Medicare Part A
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
Medicare Part B
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
POS
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
PPO
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
va
Workers Comp
I
96687.06
18996.78
18996.78
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
EPO
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
HMO
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
Medicaid
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
Medicare Part A
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
Medicare Part B
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
POS
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
PPO
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
246
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents
webtpa
Workers Comp
I
96687.06
18996.78
102531.45
102531.45
58012.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
EPO
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
HMO
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
Medicaid
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
Medicare Part A
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
Medicare Part B
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
POS
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
PPO
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
24685
null
cpt
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region
tricare
Workers Comp
O
34332.17
5299.29
5299.29
5299.29
20599.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
EPO
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
HMO
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
Medicaid
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
Medicare Part A
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
Medicare Part B
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
POS
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
PPO
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna
Workers Comp
I
77780.81
6181.26
27407.82
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
EPO
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
HMO
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
Medicaid
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
Medicare Part A
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
Medicare Part B
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
POS
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
PPO
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
aetna - medicare advantage
Workers Comp
I
77780.81
6181.26
6181.26
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
EPO
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
HMO
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
Medicaid
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
Medicare Part A
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
Medicare Part B
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
POS
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
PPO
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield
Workers Comp
I
77780.81
6181.26
20392.94
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
EPO
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
HMO
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
Medicaid
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
POS
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
PPO
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
77780.81
6181.26
17375.42
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
EPO
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
HMO
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
Medicaid
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
Medicare Part A
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
Medicare Part B
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
POS
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
PPO
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
humana - medicare advantage
Workers Comp
I
77780.81
6181.26
11995.57
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
EPO
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
HMO
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
Medicaid
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
Medicare Part A
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
Medicare Part B
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
POS
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
PPO
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
tricare
Workers Comp
I
77780.81
6181.26
15241.18
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
EPO
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
HMO
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
Medicaid
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
Medicare Part A
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
Medicare Part B
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
POS
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
PPO
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare
Workers Comp
I
77780.81
6181.26
54627.45
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
EPO
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
HMO
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
Medicaid
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
Medicare Part A
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
Medicare Part B
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
POS
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
PPO
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
united healthcare - medicare advantage
Workers Comp
I
77780.81
6181.26
12904.00
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
EPO
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
HMO
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
Medicaid
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
Medicare Part A
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
Medicare Part B
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
POS
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
PPO
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
va
Workers Comp
I
77780.81
6181.26
12303.52
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
EPO
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
HMO
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
Medicaid
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
Medicare Part A
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
Medicare Part B
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
POS
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
PPO
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
247
null
ms-drg
percutaneous cardiovascular procedures with drug-eluting stent without mcc
webtpa
Workers Comp
I
77780.81
6181.26
60705.20
60705.20
46668.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
EPO
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
HMO
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
Medicaid
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
Medicare Part A
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
Medicare Part B
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
POS
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
PPO
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
249
null
ms-drg
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc
humana - medicare advantage
Workers Comp
I
65075.76
12200.20
12200.20
12200.20
39045.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
EPO
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
HMO
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
Medicaid
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
Medicare Part A
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
Medicare Part B
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
POS
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
PPO
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
blue cross blue shield
Workers Comp
I
87562.01
15245.66
26746.13
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
EPO
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
HMO
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
Medicaid
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
Medicare Part A
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
Medicare Part B
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
POS
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
PPO
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
250
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent with mcc
humana - medicare advantage
Workers Comp
I
87562.01
15245.66
15245.66
26746.13
52537.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
EPO
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
HMO
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
Medicaid
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
Medicare Part A
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
Medicare Part B
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
POS
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
PPO
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
blue cross blue shield
Workers Comp
O
16394.40
1233.12
3931.33
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
EPO
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
HMO
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
Medicaid
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
Medicare Part A
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
Medicare Part B
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
POS
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
PPO
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25000
null
cpt
Incision or the tendon covering on the top side of the wrist
tricare
Workers Comp
O
16394.40
1233.12
1233.12
3931.33
9836.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
EPO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
HMO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
Medicaid
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
Medicare Part A
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
Medicare Part B
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
POS
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
PPO
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25075
null
cpt
Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist
tricare
Workers Comp
O
18189.24
1246.10
1246.10
1246.10
10913.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
EPO
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
HMO
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
Medicaid
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
POS
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
PPO
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
251
null
ms-drg
percutaneous cardiovascular procedures without coronary artery stent without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
60268.04
13655.76
13655.76
13655.76
36160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
EPO
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
HMO
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
Medicaid
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
Medicare Part A
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
Medicare Part B
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
POS
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
PPO
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
blue cross blue shield
Workers Comp
O
16369.65
1200.71
2879.76
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
EPO
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
HMO
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
Medicaid
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
Medicare Part A
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
Medicare Part B
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
POS
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
PPO
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25111
null
cpt
Removal of cyst at wrist initial or primary
humana - medicare advantage
Workers Comp
O
16369.65
1200.71
1200.71
2879.76
9821.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
EPO
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
HMO
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
Medicaid
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
Medicare Part A
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
Medicare Part B
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
POS
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
PPO
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25246
null
cpt
Injection of dye for X-ray imaging of wrist joint
va
Workers Comp
O
3319.18
652.02
652.02
652.02
1991.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
EPO
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
HMO
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
Medicaid
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
Medicare Part A
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
Medicare Part B
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
POS
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
PPO
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield
Workers Comp
I
63191.22
15731.90
24848.07
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
EPO
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
HMO
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
POS
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
PPO
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
63191.22
15731.90
20654.91
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
EPO
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
HMO
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
Medicaid
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
Medicare Part A
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
Medicare Part B
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
POS
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
PPO
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
cigna
Workers Comp
I
63191.22
15731.90
29514.43
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
EPO
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
HMO
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
Medicaid
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
Medicare Part A
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
Medicare Part B
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
POS
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
PPO
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
humana - medicare advantage
Workers Comp
I
63191.22
15731.90
15731.90
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
EPO
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
HMO
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
Medicaid
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
Medicare Part A
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
Medicare Part B
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
POS
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
PPO
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
253
null
ms-drg
other vascular procedures with cc
united healthcare - medicare advantage
Workers Comp
I
63191.22
15731.90
15889.23
29514.43
37914.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
EPO
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
HMO
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
Medicaid
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
Medicare Part A
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
Medicare Part B
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
POS
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
PPO
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25310
null
cpt
Relocation of tendon of forearm and/or wrist
blue cross blue shield
Workers Comp
O
17806.18
5631.69
5631.69
5631.69
10683.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
EPO
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
HMO
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
Medicaid
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
POS
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
PPO
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
blue cross blue shield
Workers Comp
I
35268.04
10776.67
15259.31
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
EPO
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
HMO
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
Medicaid
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
POS
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
PPO
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
35268.04
10776.67
10776.67
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
EPO
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
HMO
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
Medicaid
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
Medicare Part A
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
Medicare Part B
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
POS
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
PPO
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
254
null
ms-drg
other vascular procedures without cc/mcc
tricare
Workers Comp
I
35268.04
10776.67
10936.61
15259.31
21160.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
EPO
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
HMO
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
Medicaid
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
Medicare Part A
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
Medicare Part B
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
POS
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
PPO
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25447
null
cpt
Removal of bone joints between wrist and fingers
blue cross blue shield
Workers Comp
O
23288.62
5631.69
5631.69
5631.69
13973.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
EPO
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
HMO
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
Medicaid
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
Medicare Part A
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
Medicare Part B
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
POS
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
PPO
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25606
null
cpt
Insertion of hardware to lower forearm bone broken or growth plate separation accessed through the skin
tricare
Workers Comp
O
18545.16
2425.05
2425.05
2425.05
11127.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
EPO
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
HMO
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
Medicaid
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
Medicare Part A
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
Medicare Part B
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
POS
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
PPO
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
blue cross blue shield
Workers Comp
O
32000.70
5299.29
10762.22
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
EPO
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
HMO
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
Medicaid
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
Medicare Part A
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
Medicare Part B
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
POS
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
PPO
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
tricare
Workers Comp
O
32000.70
5299.29
5299.29
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
EPO
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
HMO
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
Medicaid
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
Medicare Part A
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
Medicare Part B
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
POS
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
PPO
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25607
null
cpt
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware
va
Workers Comp
O
32000.70
5299.29
10989.80
10989.80
19200.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
EPO
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
HMO
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
Medicaid
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
Medicare Part A
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
Medicare Part B
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
POS
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
PPO
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield
Workers Comp
O
31509.16
5299.29
10715.87
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
EPO
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
HMO
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
Medicaid
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
Medicare Part A
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
Medicare Part B
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
POS
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
PPO
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
blue cross blue shield - medicare advantage
Workers Comp
O
31509.16
5299.29
7889.33
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
EPO
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
HMO
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
Medicaid
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
Medicare Part A
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
Medicare Part B
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
POS
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
PPO
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25608
null
cpt
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments
tricare
Workers Comp
O
31509.16
5299.29
5299.29
10715.87
18905.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
EPO
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
HMO
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
Medicaid
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
Medicare Part A
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
Medicare Part B
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
POS
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
PPO
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25651
null
cpt
Insertion of hardware broken bone of forearm at wrist accessed through the skin
tricare
Workers Comp
O
19600.75
2425.05
2425.05
2425.05
11760.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
EPO
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
HMO
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
Medicaid
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
Medicare Part A
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
Medicare Part B
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
POS
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
PPO
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield
Workers Comp
O
32103.26
7889.33
10715.87
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
EPO
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
HMO
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
Medicaid
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
Medicare Part A
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
Medicare Part B
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
POS
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
PPO
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
25652
null
cpt
Open treatment of broken wrist
blue cross blue shield - medicare advantage
Workers Comp
O
32103.26
7889.33
7889.33
10715.87
19261.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
EPO
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
HMO
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
Medicaid
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
Medicare Part A
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
Medicare Part B
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
POS
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
PPO
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield
Workers Comp
O
16229.95
1233.12
3634.76
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
EPO
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
HMO
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
Medicaid
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
Medicare Part A
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
Medicare Part B
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
POS
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
PPO
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
blue cross blue shield - medicare advantage
Workers Comp
O
16229.95
1233.12
3647.34
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
EPO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
HMO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
Medicaid
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
Medicare Part A
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
Medicare Part B
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
POS
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
PPO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
humana - medicare advantage
Workers Comp
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
EPO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
HMO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
Medicaid
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
Medicare Part A
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
Medicare Part B
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
POS
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
PPO
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
tricare
Workers Comp
O
16229.95
1233.12
1233.12
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
EPO
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
HMO
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
Medicaid
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
Medicare Part A
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
Medicare Part B
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
POS
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
PPO
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26055
null
cpt
Incision of tendon covering
united healthcare
Workers Comp
O
16229.95
1233.12
13719.01
13719.01
9737.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
EPO
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
HMO
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
Medicaid
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
Medicare Part A
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
Medicare Part B
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
POS
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
PPO
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
blue cross blue shield
Workers Comp
O
15185.77
4794.98
4794.98
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
EPO
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
HMO
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
Medicaid
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
Medicare Part A
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
Medicare Part B
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
POS
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
PPO
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26111
null
cpt
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger
united healthcare
Workers Comp
O
15185.77
4794.98
11689.03
11689.03
9111.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
EPO
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
HMO
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
Medicaid
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
Medicare Part A
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
Medicare Part B
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
POS
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
PPO
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26116
null
cpt
Removal (less than 1.5 centimeters) muscle growth of hand or finger
blue cross blue shield - medicare advantage
Workers Comp
O
17041.83
3848.24
3848.24
3848.24
10225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
EPO
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
HMO
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
Medicaid
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
Medicare Part A
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
Medicare Part B
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
POS
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
PPO
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26160
null
cpt
Removal of growth of tendon finger or hand
tricare
Workers Comp
O
14681.56
1233.12
1233.12
1233.12
8808.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
EPO
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
HMO
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
Medicaid
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
Medicare Part A
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
Medicare Part B
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
POS
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
PPO
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26200
null
cpt
Removal or scraping of hand bone cyst or growth
humana - medicare advantage
Workers Comp
O
18223.71
1200.71
1200.71
1200.71
10934.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
EPO
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
HMO
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
Medicaid
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
Medicare Part A
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
Medicare Part B
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
POS
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
PPO
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
blue cross blue shield
Workers Comp
I
61487.64
18753.66
30770.87
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
EPO
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
HMO
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
Medicaid
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
Medicare Part A
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
Medicare Part B
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
POS
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
PPO
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
264
null
ms-drg
other circulatory system o.r. procedures
humana - medicare advantage
Workers Comp
I
61487.64
18753.66
18753.66
30770.87
36892.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
EPO
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
HMO
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
Medicaid
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
Medicare Part A
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
Medicare Part B
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
POS
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
PPO
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield
Workers Comp
O
18265.32
5508.71
10600.32
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
EPO
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
HMO
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
Medicaid
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
Medicare Part A
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
Medicare Part B
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
POS
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
PPO
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26608
null
cpt
Insertion of hardware to broken finger accessed through the skin
blue cross blue shield - medicare advantage
Workers Comp
O
18265.32
5508.71
5508.71
10600.32
10959.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
EPO
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
HMO
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
Medicaid
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
Medicare Part A
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
Medicare Part B
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
POS
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
PPO
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield
Workers Comp
O
25811.81
5398.71
10679.32
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
EPO
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
HMO
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
Medicaid
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
Medicare Part A
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
Medicare Part B
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
POS
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
PPO
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26615
null
cpt
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers
blue cross blue shield - medicare advantage
Workers Comp
O
25811.81
5398.71
5398.71
10679.32
15487.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
EPO
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
HMO
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
Medicaid
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
Medicare Part A
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
Medicare Part B
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
POS
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
PPO
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26665
null
cpt
Open treatment of broken thumb at wrist
tricare
Workers Comp
O
34027.62
2425.05
2425.05
2425.05
20416.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
EPO
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
HMO
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
Medicaid
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
Medicare Part A
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
Medicare Part B
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
POS
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
PPO
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
26756
null
cpt
Insertion of hardware to broken finger or thumb accessed through the skin
blue cross blue shield
Workers Comp
O
15009.22
5946.93
5946.93
5946.93
9005.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
EPO
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
HMO
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
Medicaid
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
Medicare Part A
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
Medicare Part B
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
POS
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
PPO
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
humana - medicare advantage
Workers Comp
I
108550.44
25192.73
25192.73
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
EPO
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
HMO
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
Medicaid
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
Medicare Part A
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
Medicare Part B
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
POS
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
PPO
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
269
null
ms-drg
aortic and heart assist procedures except pulsation balloon without mcc
va
Workers Comp
I
108550.44
25192.73
27848.77
27848.77
65130.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
EPO
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
HMO
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
Medicaid
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
Medicare Part A
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
Medicare Part B
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
POS
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
PPO
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
blue cross blue shield
Workers Comp
I
123725.73
30276.88
40581.25
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
EPO
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
HMO
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
Medicaid
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
Medicare Part A
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
Medicare Part B
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
POS
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
PPO
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
270
null
ms-drg
other major cardiovascular procedures with mcc
humana - medicare advantage
Workers Comp
I
123725.73
30276.88
30276.88
40581.25
74235.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
EPO
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
HMO
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
Medicaid
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
Medicare Part A
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
Medicare Part B
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
POS
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
PPO
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27043
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip
aetna
Workers Comp
O
15975.19
8313.56
8313.56
8313.56
9585.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
EPO
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
HMO
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
Medicaid
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
Medicare Part A
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
Medicare Part B
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
POS
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
PPO
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27093
null
cpt
Injection of dye for X-ray imaging of hip joint
tricare
Workers Comp
O
1873.16
633.79
633.79
633.79
1123.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
EPO
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
HMO
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
Medicaid
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
Medicare Part A
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
Medicare Part B
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
POS
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
PPO
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27096
null
cpt
Injection procedure into sacroiliac joint for anesthetic or steroid
tricare
Workers Comp
O
6393.89
1034.21
1034.21
1034.21
3836.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
EPO
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
HMO
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
POS
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
PPO
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
119192.48
19620.86
28452.13
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
EPO
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
HMO
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
Medicaid
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
Medicare Part A
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
Medicare Part B
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
POS
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
PPO
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
271
null
ms-drg
other major cardiovascular procedures with cc
humana - medicare advantage
Workers Comp
I
119192.48
19620.86
19620.86
28452.13
71515.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
EPO
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
HMO
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
Medicaid
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
Medicare Part A
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
Medicare Part B
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
POS
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
PPO
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27130
null
cpt
Replacement of thigh bone and hip joint prosthesis
aetna - medicare advantage
Workers Comp
I
74043.99
12271.27
12271.27
12271.27
44426.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
POS
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
272
null
ms-drg
other major cardiovascular procedures without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
55888.40
23465.69
23465.69
23465.69
33533.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
EPO
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
HMO
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
Medicaid
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
Medicare Part A
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
Medicare Part B
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
POS
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
PPO
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
aetna - medicare advantage
Workers Comp
I
77516.22
12960.51
12960.51
12960.51
46509.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
EPO
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
HMO
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
Medicaid
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
Medicare Part A
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
Medicare Part B
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
POS
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
PPO
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27235
null
cpt
Insertion of hardware to broken thigh bone accessed through the skin
tricare
Workers Comp
O
28964.53
5508.74
5508.74
5508.74
17378.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
EPO
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
HMO
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
Medicaid
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
Medicare Part A
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
Medicare Part B
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
POS
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
PPO
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27328
null
cpt
Removal (less than 5 centimeters) muscle growth of thigh or knee
aetna
Workers Comp
O
22259.89
12578.62
12578.62
12578.62
13355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
EPO
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
HMO
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
Medicaid
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
Medicare Part A
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
Medicare Part B
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
POS
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
PPO
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27337
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee
united healthcare
Workers Comp
O
15792.66
11844.50
11844.50
11844.50
9475.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
EPO
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
HMO
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
Medicaid
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
Medicare Part A
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
Medicare Part B
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
POS
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
PPO
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
blue cross blue shield - medicare advantage
Workers Comp
O
18929.90
2506.63
4056.19
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
EPO
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
HMO
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
Medicaid
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
Medicare Part A
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
Medicare Part B
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
POS
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
PPO
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27340
null
cpt
Removal of fluid-filled sac (bursa) below knee joint
va
Workers Comp
O
18929.90
2506.63
2506.63
4056.19
11357.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
EPO
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
HMO
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
Medicaid
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
Medicare Part A
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
Medicare Part B
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
POS
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
PPO
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27372
null
cpt
Removal of foreign body of thigh or knee
tricare
Workers Comp
O
17734.98
2054.26
2054.26
2054.26
10640.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
EPO
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
HMO
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
Medicaid
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
Medicare Part A
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
Medicare Part B
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
POS
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
PPO
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27380
null
cpt
Suture of tendon below knee primary
tricare
Workers Comp
O
25232.83
5548.49
5548.49
5548.49
15139.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
EPO
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
HMO
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
Medicaid
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
Medicare Part A
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
Medicare Part B
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
POS
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
PPO
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27385
null
cpt
Suture of ruptured muscle of thigh primary
humana - medicare advantage
Workers Comp
O
36445.13
5299.29
5299.29
5299.29
21867.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
EPO
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
HMO
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
Medicaid
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
Medicare Part A
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
Medicare Part B
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
POS
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
PPO
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27427
null
cpt
Reconstruction of knee joint ligaments
tricare
Workers Comp
O
45464.50
5299.29
5299.29
5299.29
27278.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
EPO
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
HMO
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
Medicaid
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
Medicare Part A
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
Medicare Part B
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
POS
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
PPO
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
blue cross blue shield
Workers Comp
O
69062.42
10906.44
24875.47
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
EPO
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
HMO
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
Medicaid
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
Medicare Part A
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
Medicare Part B
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
POS
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
PPO
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27447
null
cpt
Repair of knee joint lower or upper part of joint inside and outside area
tricare
Workers Comp
O
69062.42
10906.44
10906.44
24875.47
41437.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
EPO
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
HMO
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
Medicaid
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
Medicare Part A
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
Medicare Part B
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
POS
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
PPO
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27486
null
cpt
Revision of one component of total knee joint prosthesis
humana - medicare advantage
Workers Comp
O
32837.40
10906.44
10906.44
10906.44
19702.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
EPO
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
HMO
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
Medicaid
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
Medicare Part A
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
Medicare Part B
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
POS
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
PPO
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27524
null
cpt
Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap
humana - medicare advantage
Workers Comp
O
31622.74
5299.29
5299.29
5299.29
18973.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
EPO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
HMO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
Medicaid
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
Medicare Part A
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
Medicare Part B
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
POS
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
PPO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
humana - medicare advantage
Workers Comp
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
EPO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
HMO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
Medicaid
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
Medicare Part A
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
Medicare Part B
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
POS
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
PPO
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27570
null
cpt
Alignment of knee joint under anesthesia
tricare
Workers Comp
O
11154.13
1200.71
1200.71
1200.71
6692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
EPO
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
HMO
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
Medicaid
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
Medicare Part A
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
Medicare Part B
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
POS
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
PPO
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27620
null
cpt
Exploration of ankle joint
tricare
Workers Comp
O
33356.63
5299.29
5299.29
5299.29
20013.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
EPO
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
HMO
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
Medicaid
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
Medicare Part A
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
Medicare Part B
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
POS
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
PPO
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27626
null
cpt
Removal of membrane covering ankle joint and tendon
blue cross blue shield
Workers Comp
O
32941.39
24.54
24.54
24.54
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
EPO
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
HMO
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
Medicaid
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
Medicare Part A
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
Medicare Part B
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
POS
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
PPO
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27632
null
cpt
Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle
blue cross blue shield
Workers Comp
O
16195.95
4105.66
4105.66
4105.66
9717.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
EPO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
HMO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
Medicaid
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
Medicare Part A
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
Medicare Part B
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
POS
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
PPO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27635
null
cpt
Removal or scraping of cyst or growth of either bone of lower leg
humana - medicare advantage
Workers Comp
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
EPO
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
HMO
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
Medicaid
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
Medicare Part A
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
Medicare Part B
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
POS
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
PPO
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
blue cross blue shield
Workers Comp
O
31988.36
2262.26
9300.82
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
EPO
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
HMO
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
Medicaid
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
Medicare Part A
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
Medicare Part B
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
POS
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
PPO
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
humana - medicare advantage
Workers Comp
O
31988.36
2262.26
5299.29
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
EPO
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
HMO
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
Medicaid
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
Medicare Part A
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
Medicare Part B
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
POS
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
PPO
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
tricare
Workers Comp
O
31988.36
2262.26
2262.26
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
EPO
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
HMO
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
Medicaid
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
Medicare Part A
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
Medicare Part B
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
POS
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
PPO
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27650
null
cpt
Repair of ruptured Achilles tendon open or through skin procedure
va
Workers Comp
O
31988.36
2262.26
5548.30
9300.82
19193.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
EPO
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
HMO
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
Medicaid
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
Medicare Part A
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
Medicare Part B
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
POS
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
PPO
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27652
null
cpt
Repair of ruptured Achilles tendon with graft open or through skin procedure
tricare
Workers Comp
O
32635.10
5548.49
5548.49
5548.49
19581.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
EPO
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
HMO
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
Medicaid
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
Medicare Part A
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
Medicare Part B
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
POS
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
PPO
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield
Workers Comp
O
35245.78
5273.49
12710.32
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
EPO
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
HMO
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
Medicaid
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
Medicare Part A
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
Medicare Part B
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
POS
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
PPO
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
blue cross blue shield - medicare advantage
Workers Comp
O
35245.78
5273.49
13554.61
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
EPO
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
HMO
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
Medicaid
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
Medicare Part A
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
Medicare Part B
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
POS
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
PPO
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27654
null
cpt
Repair of ruptured Achilles tendon
humana - medicare advantage
Workers Comp
O
35245.78
5273.49
5273.49
13554.61
21147.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
EPO
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
HMO
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
Medicaid
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
Medicare Part A
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
Medicare Part B
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
POS
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
PPO
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27658
null
cpt
Repair of leg tendon on the back side of the leg (flexor) primary without graft
tricare
Workers Comp
O
19839.17
2506.72
2506.72
2506.72
11903.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
EPO
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
HMO
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
Medicaid
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
Medicare Part A
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
Medicare Part B
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
POS
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
PPO
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27664
null
cpt
Repair of leg tendon on the front of the leg (extensor) primary without graft
tricare
Workers Comp
O
27067.93
5548.49
5548.49
5548.49
16240.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
EPO
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
HMO
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
Medicaid
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
Medicare Part A
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
Medicare Part B
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
POS
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
PPO
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
aetna
Workers Comp
O
30435.34
4438.79
9252.41
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
EPO
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
HMO
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
Medicaid
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
Medicare Part A
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
Medicare Part B
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
POS
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
PPO
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
blue cross blue shield
Workers Comp
O
30435.34
4438.79
9949.68
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
EPO
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
HMO
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
Medicaid
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
Medicare Part A
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
Medicare Part B
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
POS
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
PPO
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27680
null
cpt
Release of leg and/or ankle tendon
humana - medicare advantage
Workers Comp
O
30435.34
4438.79
4438.79
9949.68
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
EPO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
HMO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
Medicaid
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
Medicare Part A
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
Medicare Part B
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
POS
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
PPO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
humana - medicare advantage
Workers Comp
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
EPO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
HMO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
Medicaid
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
Medicare Part A
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
Medicare Part B
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
POS
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
PPO
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27687
null
cpt
Lengthening of calf muscle
tricare
Workers Comp
O
22889.66
2425.05
2425.05
2425.05
13733.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
EPO
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
HMO
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
Medicaid
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
Medicare Part A
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
Medicare Part B
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
POS
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
PPO
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27691
null
cpt
Transplant of deep tendon with muscle rerouting at lower leg or ankle
tricare
Workers Comp
O
24702.32
5299.29
5299.29
5299.29
14821.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
EPO
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
HMO
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
Medicaid
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
Medicare Part A
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
Medicare Part B
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
POS
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
PPO
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27695
null
cpt
Repair of disrupted collateral ligament of ankle primary
tricare
Workers Comp
O
31310.33
5299.29
5299.29
5299.29
18786.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
EPO
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
HMO
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
Medicaid
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
Medicare Part A
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
Medicare Part B
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
POS
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
PPO
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
blue cross blue shield
Workers Comp
O
32941.39
4987.11
4987.11
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
EPO
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
HMO
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
Medicaid
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
Medicare Part A
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
Medicare Part B
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
POS
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
PPO
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27698
null
cpt
Repair of disrupted collateral ligament of ankle secondary
tricare
Workers Comp
O
32941.39
4987.11
5299.29
5299.29
19764.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
EPO
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
HMO
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
Medicaid
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
Medicare Part A
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
Medicare Part B
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
POS
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
PPO
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27704
null
cpt
Removal of ankle implant
humana - medicare advantage
Workers Comp
O
21085.69
581.83
581.83
581.83
12651.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
EPO
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
HMO
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
Medicaid
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
Medicare Part A
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
Medicare Part B
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
POS
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
PPO
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27759
null
cpt
Treatment of broken shin bone
tricare
Workers Comp
O
33050.42
10624.49
10624.49
10624.49
19830.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
EPO
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
HMO
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicaid
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicare Part A
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicare Part B
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
POS
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
PPO
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27766
null
cpt
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Workers Comp
O
24702.25
5423.89
5423.89
5423.89
14821.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
EPO
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
HMO
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
Medicaid
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
Medicare Part A
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
Medicare Part B
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
POS
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
PPO
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
blue cross blue shield
Workers Comp
O
28562.14
5299.29
13411.60
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
EPO
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
HMO
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
Medicaid
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
Medicare Part A
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
Medicare Part B
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
POS
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
PPO
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27784
null
cpt
Open treatment of the outer bone of the lower leg
tricare
Workers Comp
O
28562.14
5299.29
5299.29
13411.60
17137.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
EPO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
HMO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
Medicaid
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
Medicare Part A
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
Medicare Part B
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
POS
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
PPO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
aetna - medicare advantage
Workers Comp
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
EPO
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
HMO
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
Medicaid
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
Medicare Part A
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
Medicare Part B
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
POS
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
PPO
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
blue cross blue shield
Workers Comp
O
27854.70
5299.29
7125.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
EPO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
HMO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicaid
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicare Part A
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Medicare Part B
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
POS
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
PPO
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
tricare
Workers Comp
O
27854.70
5299.29
5299.29
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
EPO
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
HMO
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
Medicaid
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
Medicare Part A
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
Medicare Part B
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
POS
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
PPO
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27792
null
cpt
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle
united healthcare
Workers Comp
O
27854.70
5299.29
20495.82
20495.82
16712.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
EPO
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
HMO
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
Medicaid
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
Medicare Part A
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
Medicare Part B
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
POS
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
PPO
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27814
null
cpt
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation
humana - medicare advantage
Workers Comp
O
32652.03
5256.90
5256.90
5256.90
19591.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
EPO
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
HMO
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
Medicaid
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
Medicare Part A
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
Medicare Part B
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
POS
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
PPO
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27822
null
cpt
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle
humana - medicare advantage
Workers Comp
O
37177.10
5199.20
5199.20
5199.20
22306.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
EPO
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
HMO
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
Medicaid
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
Medicare Part A
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
Medicare Part B
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
POS
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
PPO
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27829
null
cpt
Open treatment of ligament tear at ankle joint
tricare
Workers Comp
O
34076.30
5548.49
5548.49
5548.49
20445.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
EPO
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
HMO
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
Medicaid
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
Medicare Part A
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
Medicare Part B
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
POS
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
PPO
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27860
null
cpt
Manipulation of ankle under general anesthesia
tricare
Workers Comp
O
21167.26
5299.29
5299.29
5299.29
12700.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
EPO
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
HMO
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
Medicaid
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
Medicare Part A
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
Medicare Part B
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
POS
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
PPO
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
27899
null
cpt
Leg or ankle procedure
blue cross blue shield
Workers Comp
O
26398.26
13411.60
13411.60
13411.60
15838.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
EPO
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
HMO
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
Medicaid
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
Medicare Part A
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
Medicare Part B
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
POS
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
PPO
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
280
null
ms-drg
acute myocardial infarction discharged alive with mcc
humana - medicare advantage
Workers Comp
I
45192.89
10196.25
10196.25
10196.25
27115.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
EPO
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
HMO
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
Medicaid
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
Medicare Part A
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
Medicare Part B
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
POS
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
PPO
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
aetna
Workers Comp
O
13487.68
2425.05
9547.67
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
EPO
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
HMO
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
Medicaid
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
Medicare Part A
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
Medicare Part B
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
POS
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
PPO
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
blue cross blue shield - medicare advantage
Workers Comp
O
13487.68
2425.05
3179.01
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
EPO
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
HMO
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
Medicaid
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
Medicare Part A
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
Medicare Part B
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
POS
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
PPO
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28008
null
cpt
Incision of tissues of muscle compartment of foot and/or toe
tricare
Workers Comp
O
13487.68
2425.05
2425.05
9547.67
8092.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
EPO
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
HMO
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
Medicaid
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
Medicare Part A
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
Medicare Part B
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
POS
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
PPO
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28043
null
cpt
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe
blue cross blue shield - medicare advantage
Workers Comp
O
16910.59
3841.83
3841.83
3841.83
10146.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
EPO
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
HMO
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
Medicaid
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
Medicare Part A
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
Medicare Part B
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
POS
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
PPO
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
aetna
Workers Comp
O
16486.37
1200.71
9425.24
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
EPO
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
HMO
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
Medicaid
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
Medicare Part A
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
Medicare Part B
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
POS
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
PPO
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28080
null
cpt
Removal of fibrous nerve growth from between toes
tricare
Workers Comp
O
16486.37
1200.71
1200.71
9425.24
9891.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
EPO
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
HMO
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
Medicaid
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
Medicare Part A
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
Medicare Part B
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
POS
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
PPO
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28103
null
cpt
Removal or scraping of bone cyst or growth of heel bone with donor bone graft
tricare
Workers Comp
O
18532.40
5299.29
5299.29
5299.29
11119.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
EPO
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
HMO
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
Medicaid
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
Medicare Part A
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
Medicare Part B
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
POS
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
PPO
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28108
null
cpt
Removal or scraping of bone cyst or growth of toes
blue cross blue shield - medicare advantage
Workers Comp
O
15249.42
5335.38
5335.38
5335.38
9149.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
EPO
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
HMO
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
Medicaid
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
Medicare Part A
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
Medicare Part B
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
POS
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
PPO
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28110
null
cpt
Removal of bunion at fifth toe joint
tricare
Workers Comp
O
18166.33
2506.72
2506.72
2506.72
10899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
EPO
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
HMO
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
Medicaid
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
Medicare Part A
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
Medicare Part B
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
POS
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
PPO
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28118
null
cpt
Removal of heel bone
humana - medicare advantage
Workers Comp
O
30905.17
5299.29
5299.29
5299.29
18543.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
EPO
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
HMO
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
Medicaid
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
Medicare Part A
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
Medicare Part B
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
POS
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
PPO
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield
Workers Comp
O
34000.34
5273.49
6502.08
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
EPO
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
HMO
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
Medicaid
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
Medicare Part A
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
Medicare Part B
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
POS
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
PPO
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
blue cross blue shield - medicare advantage
Workers Comp
O
34000.34
5273.49
13554.61
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
EPO
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
HMO
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
Medicaid
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
Medicare Part A
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
Medicare Part B
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
POS
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
PPO
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
humana - medicare advantage
Workers Comp
O
34000.34
5273.49
5273.49
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
EPO
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
HMO
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
Medicaid
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
Medicare Part A
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
Medicare Part B
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
POS
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
PPO
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28119
null
cpt
Removal of heel bone spur
va
Workers Comp
O
34000.34
5273.49
5548.30
13554.61
20400.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
EPO
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
HMO
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
Medicaid
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
Medicare Part A
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
Medicare Part B
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
POS
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
PPO
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
aetna
Workers Comp
O
22861.77
5612.55
9252.41
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
EPO
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
HMO
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
Medicaid
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
Medicare Part A
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
Medicare Part B
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
POS
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
PPO
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield
Workers Comp
O
22861.77
5612.55
9300.82
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
EPO
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
HMO
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
Medicaid
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
Medicare Part A
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
Medicare Part B
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
POS
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
PPO
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
blue cross blue shield - medicare advantage
Workers Comp
O
22861.77
5612.55
5612.55
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
EPO
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
HMO
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
Medicaid
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
Medicare Part A
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
Medicare Part B
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
POS
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
PPO
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28120
null
cpt
Partial removal of foot or heel bone for bone infection in the mid hindfoot area
va
Workers Comp
O
22861.77
5612.55
10906.07
10906.07
13717.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
EPO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
HMO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
Medicaid
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
Medicare Part A
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
Medicare Part B
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
POS
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
PPO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
humana - medicare advantage
Workers Comp
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
EPO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
HMO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
Medicaid
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
Medicare Part A
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
Medicare Part B
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
POS
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
PPO
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28122
null
cpt
Partial removal of foot or heel bone for bone infection in the midfoot area
tricare
Workers Comp
O
20501.61
2425.05
2425.05
2425.05
12300.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
EPO
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
HMO
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
Medicaid
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
Medicare Part A
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
Medicare Part B
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
POS
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
PPO
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28124
null
cpt
Partial removal of toe bone
humana - medicare advantage
Workers Comp
O
16701.85
2383.75
2383.75
2383.75
10021.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
EPO
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
HMO
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
Medicaid
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
Medicare Part A
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
Medicare Part B
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
POS
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
PPO
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
humana - medicare advantage
Workers Comp
I
32104.28
4599.69
4599.69
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
EPO
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
HMO
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
Medicaid
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
Medicare Part A
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
Medicare Part B
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
POS
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
PPO
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
282
null
ms-drg
acute myocardial infarction discharged alive without cc/mcc
united healthcare
Workers Comp
I
32104.28
4599.69
24078.21
24078.21
19262.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
EPO
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
HMO
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
Medicaid
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
Medicare Part A
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
Medicare Part B
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
POS
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
PPO
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
aetna
Workers Comp
O
19340.45
2425.05
10599.94
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
EPO
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
HMO
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
Medicaid
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
Medicare Part A
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
Medicare Part B
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
POS
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
PPO
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
blue cross blue shield
Workers Comp
O
19340.45
2425.05
8225.88
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
EPO
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
HMO
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
Medicaid
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
Medicare Part A
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
Medicare Part B
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
POS
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
PPO
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28200
null
cpt
Repair of foot tendon on the sole of the foot without a graft
tricare
Workers Comp
O
19340.45
2425.05
2425.05
10599.94
11604.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
EPO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
HMO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
Medicaid
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
Medicare Part A
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
Medicare Part B
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
POS
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
PPO
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28202
null
cpt
Repair of foot tendon on the sole of the foot with a graft
humana - medicare advantage
Workers Comp
O
30435.34
4438.79
4438.79
4438.79
18261.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
EPO
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
HMO
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
Medicaid
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
Medicare Part A
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
Medicare Part B
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
POS
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
PPO
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28232
null
cpt
Incision to lengthen toe tendon open procedure
humana - medicare advantage
Workers Comp
O
16419.52
2383.10
2383.10
2383.10
9851.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
EPO
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
HMO
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
Medicaid
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
Medicare Part A
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
Medicare Part B
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
POS
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
PPO
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28270
null
cpt
Incision of joint capsule of foot and toe
humana - medicare advantage
Workers Comp
O
24162.16
2425.05
2425.05
2425.05
14497.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
EPO
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
HMO
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
Medicaid
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
Medicare Part A
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
Medicare Part B
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
POS
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
PPO
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
blue cross blue shield - medicare advantage
Workers Comp
O
16978.23
2382.75
5335.38
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
EPO
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
HMO
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
Medicaid
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
Medicare Part A
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
Medicare Part B
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
POS
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
PPO
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
humana - medicare advantage
Workers Comp
O
16978.23
2382.75
2382.75
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
EPO
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
HMO
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
Medicaid
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
Medicare Part A
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
Medicare Part B
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
POS
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
PPO
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28285
null
cpt
Correction of toe joint deformity
tricare
Workers Comp
O
16978.23
2382.75
5299.29
5335.38
10186.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
EPO
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
HMO
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
Medicaid
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
Medicare Part A
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
Medicare Part B
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
POS
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
PPO
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28288
null
cpt
Removal of foot bone spur
humana - medicare advantage
Workers Comp
O
14711.64
2506.72
2506.72
2506.72
8826.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
EPO
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
HMO
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
Medicaid
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
Medicare Part A
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
Medicare Part B
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
POS
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
PPO
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
blue cross blue shield
Workers Comp
O
48355.28
4161.37
6374.66
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
EPO
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
HMO
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
Medicaid
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
Medicare Part A
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
Medicare Part B
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
POS
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
PPO
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28291
null
cpt
Correction of rigid deformity of first joint of big toe using implant
humana - medicare advantage
Workers Comp
O
48355.28
4161.37
4161.37
6374.66
29013.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
EPO
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
HMO
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
Medicaid
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
Medicare Part A
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
Medicare Part B
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
POS
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
PPO
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield
Workers Comp
O
40107.08
2425.05
11070.31
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
EPO
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
HMO
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
Medicaid
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
Medicare Part A
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
Medicare Part B
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
POS
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
PPO
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
blue cross blue shield - medicare advantage
Workers Comp
O
40107.08
2425.05
9586.36
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
EPO
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
HMO
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
Medicaid
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
Medicare Part A
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
Medicare Part B
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
POS
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
PPO
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28292
null
cpt
Correction of bunion with removal of the base of the great toe
tricare
Workers Comp
O
40107.08
2425.05
2425.05
11070.31
24064.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
EPO
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
HMO
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
Medicaid
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
Medicare Part A
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
Medicare Part B
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
POS
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
PPO
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
blue cross blue shield
Workers Comp
O
19661.54
2425.05
8282.99
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
EPO
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
HMO
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
Medicaid
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
Medicare Part A
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
Medicare Part B
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
POS
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
PPO
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
humana - medicare advantage
Workers Comp
O
19661.54
2425.05
2425.05
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
EPO
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
HMO
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
Medicaid
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
Medicare Part A
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
Medicare Part B
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
POS
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
PPO
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28296
null
cpt
Correction of bunion with alignment correction of midfoot bone (metatarsal) towards toe areas
tricare
Workers Comp
O
19661.54
2425.05
3903.01
8282.99
11796.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
EPO
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
HMO
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
Medicaid
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
Medicare Part A
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
Medicare Part B
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
POS
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
PPO
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28297
null
cpt
Correction of bunion with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)
blue cross blue shield
Workers Comp
O
43822.25
5382.42
5382.42
5382.42
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
EPO
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
HMO
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
Medicaid
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
Medicare Part A
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
Medicare Part B
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
POS
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
PPO
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28315
null
cpt
Removal of small bone underlying long bone of foot at toe joint
humana - medicare advantage
Workers Comp
O
15850.81
2506.72
2506.72
2506.72
9510.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
EPO
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
HMO
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
Medicaid
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
Medicare Part A
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
Medicare Part B
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
POS
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
PPO
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
284
null
ms-drg
acute myocardial infarction expired with cc
aetna - medicare advantage
Workers Comp
I
25747.19
4718.23
4718.23
4718.23
15448.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
EPO
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
HMO
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
Medicaid
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
Medicare Part A
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
Medicare Part B
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
POS
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
PPO
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
blue cross blue shield
Workers Comp
O
30887.96
5392.47
5392.47
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
EPO
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
HMO
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
Medicaid
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
Medicare Part A
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
Medicare Part B
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
POS
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
PPO
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28485
null
cpt
Open treatment of fracture of the mid portion of the foot
tricare
Workers Comp
O
30887.96
5392.47
5548.49
5548.49
18532.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
EPO
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
HMO
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
Medicaid
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
Medicare Part A
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
Medicare Part B
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
POS
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
PPO
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield
Workers Comp
I
53005.96
12614.16
21683.73
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
EPO
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
HMO
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
Medicaid
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
POS
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
PPO
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
53005.96
12614.16
20722.79
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
EPO
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
HMO
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
Medicaid
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
Medicare Part A
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
Medicare Part B
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
POS
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
PPO
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
286
null
ms-drg
circulatory disorders except ami with cardiac catheterization with mcc
humana - medicare advantage
Workers Comp
I
53005.96
12614.16
12614.16
21683.73
31803.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
EPO
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
HMO
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
Medicaid
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
Medicare Part A
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
Medicare Part B
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
POS
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
PPO
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28615
null
cpt
Open treatment of dislocation at the connection of the midfoot to the forefoot
united healthcare
Workers Comp
O
35517.98
26638.49
26638.49
26638.49
21310.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
EPO
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
HMO
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
Medicaid
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
Medicare Part A
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
Medicare Part B
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
POS
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
PPO
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
aetna
Workers Comp
I
36154.61
7079.92
7333.25
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
EPO
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
HMO
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
Medicaid
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
Medicare Part A
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
Medicare Part B
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
POS
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
PPO
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
blue cross blue shield
Workers Comp
I
36154.61
7079.92
11462.98
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
EPO
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
HMO
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
Medicaid
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
Medicare Part A
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
Medicare Part B
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
POS
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
PPO
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
humana - medicare advantage
Workers Comp
I
36154.61
7079.92
7079.92
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
EPO
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
HMO
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
Medicaid
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
Medicare Part A
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
Medicare Part B
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
POS
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
PPO
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
tricare
Workers Comp
I
36154.61
7079.92
7827.29
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
EPO
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
HMO
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
Medicaid
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
Medicare Part A
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
Medicare Part B
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
POS
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
PPO
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
united healthcare
Workers Comp
I
36154.61
7079.92
20454.64
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
EPO
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
HMO
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
Medicaid
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
Medicare Part A
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
Medicare Part B
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
POS
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
PPO
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
287
null
ms-drg
circulatory disorders except ami with cardiac catheterization without mcc
va
Workers Comp
I
36154.61
7079.92
7795.42
20454.64
21692.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
EPO
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
HMO
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
Medicaid
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
Medicare Part A
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
Medicare Part B
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
POS
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
PPO
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28715
null
cpt
Fusion of three major bones of the hindfoot
united healthcare - medicare advantage
Workers Comp
O
97498.87
9054.44
9054.44
9054.44
58499.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
EPO
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
HMO
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
Medicaid
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
Medicare Part A
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
Medicare Part B
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
POS
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
PPO
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28725
null
cpt
Fusion of foot below the ankle simple
va
Workers Comp
O
26001.91
10906.07
10906.07
10906.07
15601.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
EPO
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
HMO
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
Medicaid
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
Medicare Part A
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
Medicare Part B
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
POS
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
PPO
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield
Workers Comp
O
43822.25
5382.42
5382.42
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
EPO
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
HMO
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
Medicaid
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
Medicare Part A
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
Medicare Part B
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
POS
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
PPO
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28730
null
cpt
Fusion of multiple foot joints without a bone incision
blue cross blue shield - medicare advantage
Workers Comp
O
43822.25
5382.42
9586.36
9586.36
26293.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
EPO
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
HMO
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
Medicaid
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
Medicare Part A
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
Medicare Part B
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
POS
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
PPO
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
blue cross blue shield
Workers Comp
O
44736.99
9054.44
11070.31
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
EPO
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
HMO
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
Medicaid
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
Medicare Part A
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
Medicare Part B
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
POS
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
PPO
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28740
null
cpt
Fusion of foot in the midfoot region
united healthcare - medicare advantage
Workers Comp
O
44736.99
9054.44
9054.44
11070.31
26842.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
EPO
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
HMO
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
Medicaid
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
Medicare Part A
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
Medicare Part B
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
POS
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
PPO
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28750
null
cpt
Fusion of great toe at the joint with the foot
blue cross blue shield
Workers Comp
O
34226.58
7382.97
7382.97
7382.97
20535.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
EPO
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
HMO
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
Medicaid
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
Medicare Part A
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
Medicare Part B
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
POS
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
PPO
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
288
null
ms-drg
acute and subacute endocarditis with mcc
blue cross blue shield
Workers Comp
I
93437.75
30466.13
30466.13
30466.13
56062.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
EPO
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
HMO
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
Medicaid
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
Medicare Part A
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
Medicare Part B
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
POS
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
PPO
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28805
null
cpt
Amputation of foot across instep
humana - medicare advantage
Workers Comp
O
21247.08
2425.05
2425.05
2425.05
12748.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
EPO
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
HMO
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
Medicaid
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
Medicare Part A
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
Medicare Part B
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
POS
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
PPO
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
blue cross blue shield - medicare advantage
Workers Comp
O
15895.06
2425.05
6315.11
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
EPO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
HMO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
Medicaid
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
Medicare Part A
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
Medicare Part B
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
POS
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
PPO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
humana - medicare advantage
Workers Comp
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
EPO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
HMO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
Medicaid
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
Medicare Part A
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
Medicare Part B
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
POS
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
PPO
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28810
null
cpt
Amputation of toe and midfoot bone
tricare
Workers Comp
O
15895.06
2425.05
2425.05
6315.11
9537.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
EPO
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
HMO
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
Medicaid
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
Medicare Part A
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
Medicare Part B
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
POS
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
PPO
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28820
null
cpt
Amputation of toe at joint between the forefoot and toes
humana - medicare advantage
Workers Comp
O
14307.86
2382.45
2382.45
2382.45
8584.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
EPO
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
HMO
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
Medicaid
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
Medicare Part A
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
Medicare Part B
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
POS
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
PPO
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
28825
null
cpt
Amputation of toe at toe joints
humana - medicare advantage
Workers Comp
O
16382.64
2506.72
2506.72
2506.72
9829.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
EPO
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
HMO
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
Medicaid
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
Medicare Part A
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
Medicare Part B
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
POS
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
PPO
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna
Workers Comp
I
25368.80
6706.49
8469.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
EPO
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
HMO
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
Medicaid
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
Medicare Part A
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
Medicare Part B
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
POS
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
PPO
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
aetna - medicare advantage
Workers Comp
I
25368.80
6706.49
8347.25
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
EPO
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
HMO
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
Medicaid
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
Medicare Part A
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
Medicare Part B
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
POS
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
PPO
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield
Workers Comp
I
25368.80
6706.49
14114.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
EPO
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
HMO
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
Medicaid
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
POS
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
PPO
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
25368.80
6706.49
12121.57
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
EPO
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
HMO
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
Medicaid
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
Medicare Part A
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
Medicare Part B
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
POS
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
PPO
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
humana - medicare advantage
Workers Comp
I
25368.80
6706.49
8305.92
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
EPO
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
HMO
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
Medicaid
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
Medicare Part A
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
Medicare Part B
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
POS
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
PPO
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
tricare
Workers Comp
I
25368.80
6706.49
6706.49
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
EPO
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
HMO
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
Medicaid
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
Medicare Part A
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
Medicare Part B
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
POS
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
PPO
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare
Workers Comp
I
25368.80
6706.49
14315.31
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
EPO
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
HMO
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
Medicaid
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
Medicare Part A
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
Medicare Part B
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
POS
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
PPO
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
united healthcare - medicare advantage
Workers Comp
I
25368.80
6706.49
8796.03
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
EPO
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
HMO
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
Medicaid
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
Medicare Part A
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
Medicare Part B
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
POS
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
PPO
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
291
null
ms-drg
heart failure and shock with mcc
va
Workers Comp
I
25368.80
6706.49
8605.33
14315.31
15221.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
EPO
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
HMO
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
Medicaid
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
Medicare Part A
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
Medicare Part B
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
POS
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
PPO
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29126
null
cpt
Application of moveable hinged short arm splint (forearm to hand)
tricare
Workers Comp
O
200.46
96.59
96.59
96.59
120.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
EPO
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
HMO
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
Medicaid
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
POS
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
PPO
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
blue cross blue shield - medicare advantage
Workers Comp
I
18494.80
4900.23
8412.43
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
EPO
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
HMO
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
Medicaid
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
Medicare Part A
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
Medicare Part B
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
POS
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
PPO
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
humana - medicare advantage
Workers Comp
I
18494.80
4900.23
4900.23
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
EPO
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
HMO
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
Medicaid
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
Medicare Part A
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
Medicare Part B
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
POS
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
PPO
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
united healthcare
Workers Comp
I
18494.80
4900.23
22045.55
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
EPO
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
HMO
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
Medicaid
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
Medicare Part A
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
Medicare Part B
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
POS
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
PPO
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
292
null
ms-drg
heart failure and shock with cc
va
Workers Comp
I
18494.80
4900.23
5806.21
22045.55
11096.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
EPO
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
HMO
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
Medicaid
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
Medicare Part A
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
Medicare Part B
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
POS
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
PPO
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
blue cross blue shield - medicare advantage
Workers Comp
O
1118.68
125.03
709.59
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
EPO
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
HMO
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
Medicaid
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
Medicare Part A
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
Medicare Part B
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
POS
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
PPO
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29581
null
cpt
Application of vein wound compression system lower leg below knee including ankle and foot
va
Workers Comp
O
1118.68
125.03
125.03
709.59
671.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
EPO
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
HMO
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
Medicaid
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
Medicare Part A
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
Medicare Part B
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
POS
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
PPO
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
297
null
ms-drg
cardiac arrest unexplained with cc
humana - medicare advantage
Workers Comp
I
30414.70
4818.59
4818.59
4818.59
18248.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
EPO
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
HMO
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
POS
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
PPO
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
33913.57
5299.29
12148.74
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
EPO
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
HMO
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
Medicaid
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
Medicare Part A
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
Medicare Part B
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
POS
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
PPO
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29806
null
cpt
Incision of should joint capsule using an endoscope
tricare
Workers Comp
O
33913.57
5299.29
5299.29
12148.74
20348.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
EPO
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
HMO
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
Medicaid
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
Medicare Part A
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
Medicare Part B
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
POS
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
PPO
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
blue cross blue shield
Workers Comp
O
34869.38
5548.49
16373.52
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
EPO
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
HMO
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
Medicaid
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
Medicare Part A
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
Medicare Part B
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
POS
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
PPO
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29807
null
cpt
Repair of shoulder socket cartilage using an endoscope
tricare
Workers Comp
O
34869.38
5548.49
5548.49
16373.52
20921.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
EPO
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
HMO
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
Medicaid
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
Medicare Part A
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
Medicare Part B
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
POS
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
PPO
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29820
null
cpt
Partial removal of shoulder joint lining using an endoscope
blue cross blue shield
Workers Comp
O
36635.41
16567.36
16567.36
16567.36
21981.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
EPO
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
HMO
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicaid
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicare Part A
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicare Part B
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
POS
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
PPO
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
blue cross blue shield
Workers Comp
O
25066.99
2425.05
5593.31
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
EPO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
HMO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicaid
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicare Part A
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicare Part B
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
POS
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
PPO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Workers Comp
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
EPO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
HMO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
Medicaid
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
Medicare Part A
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
Medicare Part B
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
POS
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
PPO
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
tricare
Workers Comp
O
25066.99
2425.05
2425.05
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
EPO
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
HMO
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
Medicaid
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
Medicare Part A
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
Medicare Part B
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
POS
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
PPO
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29822
null
cpt
Removal of shoulder joint tissue using an endoscope
va
Workers Comp
O
25066.99
2425.05
2506.63
5593.31
15040.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
EPO
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
HMO
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicaid
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicare Part A
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
Medicare Part B
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
POS
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
PPO
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield
Workers Comp
O
26071.96
2425.05
13722.97
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
EPO
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
HMO
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
POS
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
PPO
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
26071.96
2425.05
4950.58
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
EPO
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
HMO
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicaid
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicare Part A
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Medicare Part B
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
POS
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
PPO
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
humana - medicare advantage
Workers Comp
O
26071.96
2425.05
2425.05
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
EPO
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
HMO
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
Medicaid
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
Medicare Part A
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
Medicare Part B
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
POS
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
PPO
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
tricare
Workers Comp
O
26071.96
2425.05
4915.10
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
EPO
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
HMO
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
Medicaid
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
Medicare Part A
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
Medicare Part B
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
POS
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
PPO
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29823
null
cpt
Extensive removal of shoulder joint tissue using an endoscope
va
Workers Comp
O
26071.96
2425.05
9907.54
13722.97
15643.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
EPO
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
HMO
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
Medicaid
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
Medicare Part A
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
Medicare Part B
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
POS
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
PPO
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield
Workers Comp
O
30999.35
5299.29
6427.57
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
EPO
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
HMO
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
POS
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
PPO
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
30999.35
5299.29
6371.70
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
EPO
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
HMO
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
Medicaid
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
Medicare Part A
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
Medicare Part B
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
POS
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
PPO
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
tricare
Workers Comp
O
30999.35
5299.29
5299.29
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
EPO
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
HMO
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
Medicaid
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
Medicare Part A
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
Medicare Part B
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
POS
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
PPO
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29824
null
cpt
Partial removal of collar bone at shoulder using an endoscope
va
Workers Comp
O
30999.35
5299.29
5548.30
6427.57
18599.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
EPO
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
HMO
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
Medicaid
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
Medicare Part A
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
Medicare Part B
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
POS
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
PPO
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield
Workers Comp
O
26333.98
2425.05
6601.70
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
EPO
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
HMO
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
POS
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
PPO
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
26333.98
2425.05
5633.11
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
EPO
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
HMO
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
Medicaid
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
Medicare Part A
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
Medicare Part B
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
POS
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
PPO
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
humana - medicare advantage
Workers Comp
O
26333.98
2425.05
2506.72
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
EPO
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
HMO
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
Medicaid
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
Medicare Part A
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
Medicare Part B
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
POS
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
PPO
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29825
null
cpt
Release or removal of shoulder scar tissue using an endoscope
tricare
Workers Comp
O
26333.98
2425.05
2425.05
6601.70
15800.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
EPO
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
HMO
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
Medicaid
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
Medicare Part A
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
Medicare Part B
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
POS
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
PPO
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield
Workers Comp
O
29567.21
2465.89
14026.67
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
EPO
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
HMO
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
POS
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
PPO
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
29567.21
2465.89
5685.55
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
EPO
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
HMO
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
Medicaid
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
Medicare Part A
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
Medicare Part B
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
POS
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
PPO
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
humana - medicare advantage
Workers Comp
O
29567.21
2465.89
2465.89
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
EPO
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
HMO
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
Medicaid
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
Medicare Part A
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
Medicare Part B
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
POS
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
PPO
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
tricare
Workers Comp
O
29567.21
2465.89
4915.10
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
EPO
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
HMO
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
Medicaid
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
Medicare Part A
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
Medicare Part B
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
POS
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
PPO
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29826
null
cpt
Shaving of shoulder bone using an endoscope
va
Workers Comp
O
29567.21
2465.89
4027.47
14026.67
6359.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
EPO
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
HMO
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
Medicaid
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
Medicare Part A
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
Medicare Part B
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
POS
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
PPO
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield
Workers Comp
O
33016.19
2425.05
16468.39
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
EPO
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
HMO
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
POS
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
PPO
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
33016.19
2425.05
10432.00
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
EPO
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
HMO
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
Medicaid
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
Medicare Part A
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
Medicare Part B
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
POS
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
PPO
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
humana - medicare advantage
Workers Comp
O
33016.19
2425.05
2425.05
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
EPO
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
HMO
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
Medicaid
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
Medicare Part A
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
Medicare Part B
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
POS
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
PPO
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29827
null
cpt
Repair of shoulder rotator cuff using an endoscope
tricare
Workers Comp
O
33016.19
2425.05
5299.29
16468.39
19809.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
EPO
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
HMO
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
Medicaid
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
Medicare Part A
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
Medicare Part B
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
POS
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
PPO
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
blue cross blue shield
Workers Comp
O
31733.81
5107.20
6466.87
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
EPO
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
HMO
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
Medicaid
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
Medicare Part A
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
Medicare Part B
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
POS
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
PPO
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29828
null
cpt
Release of shoulder biceps tendon using an endoscope
tricare
Workers Comp
O
31733.81
5107.20
5107.20
6466.87
19040.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
EPO
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
HMO
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
Medicaid
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
Medicare Part A
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
Medicare Part B
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
POS
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
PPO
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29871
null
cpt
Irrigation and drainage of knee joint for infection using an endoscope
blue cross blue shield
Workers Comp
O
21995.65
7486.83
7486.83
7486.83
13197.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
EPO
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
HMO
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
Medicaid
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
Medicare Part A
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
Medicare Part B
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
POS
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
PPO
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29874
null
cpt
Removal of loose or foreign body of knee joint using an endoscope
tricare
Workers Comp
O
19362.69
2425.05
2425.05
2425.05
11617.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
EPO
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
HMO
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
Medicaid
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
Medicare Part A
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
Medicare Part B
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
POS
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
PPO
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
blue cross blue shield
Workers Comp
O
21983.33
2434.39
5454.29
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
EPO
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
HMO
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
Medicaid
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
Medicare Part A
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
Medicare Part B
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
POS
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
PPO
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29875
null
cpt
Partial removal of knee joint lining using an endoscope
tricare
Workers Comp
O
21983.33
2434.39
2434.39
5454.29
13190.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
EPO
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
HMO
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
Medicaid
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
Medicare Part A
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
Medicare Part B
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
POS
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
PPO
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
blue cross blue shield
Workers Comp
O
19434.20
2425.05
7439.25
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
EPO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
HMO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
Medicaid
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
Medicare Part A
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
Medicare Part B
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
POS
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
PPO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
tricare
Workers Comp
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
EPO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
HMO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
Medicaid
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
Medicare Part A
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
Medicare Part B
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
POS
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
PPO
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
united healthcare - medicare advantage
Workers Comp
O
19434.20
2425.05
2425.05
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
EPO
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
HMO
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
Medicaid
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
Medicare Part A
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
Medicare Part B
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
POS
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
PPO
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29876
null
cpt
Removal of joint lining from two or more knee joint compartments using an endoscope
va
Workers Comp
O
19434.20
2425.05
2506.63
7439.25
11660.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
EPO
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
HMO
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
Medicaid
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
Medicare Part A
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
Medicare Part B
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
POS
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
PPO
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
blue cross blue shield
Workers Comp
O
18465.48
2066.60
6504.00
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
EPO
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
HMO
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
Medicaid
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
Medicare Part A
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
Medicare Part B
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
POS
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
PPO
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
humana - medicare advantage
Workers Comp
O
18465.48
2066.60
2066.60
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
EPO
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
HMO
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
Medicaid
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
Medicare Part A
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
Medicare Part B
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
POS
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
PPO
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
tricare
Workers Comp
O
18465.48
2066.60
2425.05
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
EPO
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
HMO
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
Medicaid
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
Medicare Part A
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
Medicare Part B
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
POS
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
PPO
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29877
null
cpt
Removal or shaving of knee joint cartilage using an endoscope
united healthcare
Workers Comp
O
18465.48
2066.60
12261.12
12261.12
11079.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
EPO
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
HMO
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
Medicaid
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
Medicare Part A
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
Medicare Part B
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
POS
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
PPO
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29879
null
cpt
Repair of knee joint with drilling and or scraping of the joint
tricare
Workers Comp
O
19126.94
2425.05
2425.05
2425.05
11476.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
EPO
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
HMO
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
Medicaid
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
Medicare Part A
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
Medicare Part B
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
POS
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
PPO
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield
Workers Comp
O
20856.62
2343.94
7437.24
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
EPO
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
HMO
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
POS
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
PPO
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
20856.62
2343.94
5468.57
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
EPO
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
HMO
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
Medicaid
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
Medicare Part A
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
Medicare Part B
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
POS
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
PPO
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
humana - medicare advantage
Workers Comp
O
20856.62
2343.94
2343.94
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
EPO
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
HMO
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
Medicaid
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
Medicare Part A
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
Medicare Part B
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
POS
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
PPO
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
tricare
Workers Comp
O
20856.62
2343.94
2465.89
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
EPO
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
HMO
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
Medicaid
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
Medicare Part A
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
Medicare Part B
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
POS
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
PPO
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare
Workers Comp
O
20856.62
2343.94
16311.44
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
EPO
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
HMO
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
Medicaid
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
Medicare Part A
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
Medicare Part B
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
POS
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
PPO
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
united healthcare - medicare advantage
Workers Comp
O
20856.62
2343.94
2425.05
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
EPO
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
HMO
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
Medicaid
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
Medicare Part A
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
Medicare Part B
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
POS
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
PPO
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29880
null
cpt
Removal of both knee cartilages using an endoscope
va
Workers Comp
O
20856.62
2343.94
2442.86
16311.44
12513.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
EPO
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
HMO
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
Medicaid
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
Medicare Part A
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
Medicare Part B
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
POS
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
PPO
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
aetna
Workers Comp
O
18959.07
2425.05
12842.15
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
EPO
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
HMO
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
Medicaid
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
Medicare Part A
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
Medicare Part B
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
POS
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
PPO
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield
Workers Comp
O
18959.07
2425.05
6571.24
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
EPO
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
HMO
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
Medicaid
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
Medicare Part A
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
Medicare Part B
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
POS
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
PPO
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
blue cross blue shield - medicare advantage
Workers Comp
O
18959.07
2425.05
6481.33
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
EPO
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
HMO
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
Medicaid
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
Medicare Part A
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
Medicare Part B
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
POS
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
PPO
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
humana - medicare advantage
Workers Comp
O
18959.07
2425.05
2465.89
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
EPO
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
HMO
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
Medicaid
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
Medicare Part A
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
Medicare Part B
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
POS
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
PPO
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
tricare
Workers Comp
O
18959.07
2425.05
2425.05
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
EPO
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
HMO
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
Medicaid
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
Medicare Part A
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
Medicare Part B
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
POS
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
PPO
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29881
null
cpt
Knee Scope - ONE KNEE
va
Workers Comp
O
18959.07
2425.05
2442.86
12842.15
2910.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
EPO
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
HMO
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
Medicaid
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
Medicare Part A
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
Medicare Part B
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
POS
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
PPO
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29882
null
cpt
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)
tricare
Workers Comp
O
34106.15
10542.60
10542.60
10542.60
20463.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
EPO
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
HMO
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
Medicaid
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
Medicare Part A
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
Medicare Part B
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
POS
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
PPO
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29884
null
cpt
Repair of knee joint and removal of scar tissue using an endoscope
tricare
Workers Comp
O
23144.74
2506.72
2506.72
2506.72
13886.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
EPO
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
HMO
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
Medicaid
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
Medicare Part A
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
Medicare Part B
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
POS
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
PPO
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29888
null
cpt
Repair of anterior cruciate ligament of knee with assistance of an endoscope
tricare
Workers Comp
O
44693.79
5299.29
5299.29
5299.29
26816.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
EPO
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
HMO
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
Medicaid
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
Medicare Part A
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
Medicare Part B
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
POS
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
PPO
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
29898
null
cpt
Removal of dead or infected ankle joint tissue using an endoscope
tricare
Workers Comp
O
41474.21
5299.29
5299.29
5299.29
24884.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
EPO
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
HMO
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
Medicaid
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
Medicare Part A
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
Medicare Part B
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
POS
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
PPO
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield
Workers Comp
I
33749.89
10083.64
15876.00
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
EPO
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
HMO
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
Medicaid
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
POS
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
PPO
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
299
null
ms-drg
peripheral vascular disorders with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
33749.89
10083.64
10083.64
15876.00
20249.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
EPO
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
HMO
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
Medicaid
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
POS
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
PPO
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
300
null
ms-drg
peripheral vascular disorders with cc
blue cross blue shield - medicare advantage
Workers Comp
I
22836.10
11743.17
11743.17
11743.17
13701.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
EPO
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
HMO
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
Medicaid
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
Medicare Part A
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
Medicare Part B
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
POS
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
PPO
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
301
null
ms-drg
peripheral vascular disorders without cc/mcc
tricare
Workers Comp
I
18260.10
3764.88
3764.88
3764.88
10956.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
EPO
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
HMO
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
Medicaid
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
Medicare Part A
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
Medicare Part B
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
POS
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
PPO
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
blue cross blue shield
Workers Comp
O
41621.23
4819.51
7551.65
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
EPO
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
HMO
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
Medicaid
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
Medicare Part A
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
Medicare Part B
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
POS
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
PPO
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30115
null
cpt
Removal of polyps in nose extensive or complex
tricare
Workers Comp
O
41621.23
4819.51
4819.51
7551.65
24972.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
EPO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
HMO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
Medicaid
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
Medicare Part A
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
Medicare Part B
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
POS
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
PPO
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30117
null
cpt
Removal or destruction of growth in nose internal approach
humana - medicare advantage
Workers Comp
O
26014.96
2423.46
2423.46
2423.46
15608.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
EPO
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
HMO
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
Medicaid
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
Medicare Part A
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
Medicare Part B
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
POS
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
PPO
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
blue cross blue shield
Workers Comp
O
29665.95
2423.46
7799.50
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
EPO
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
HMO
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
Medicaid
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
Medicare Part A
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
Medicare Part B
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
POS
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
PPO
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
humana - medicare advantage
Workers Comp
O
29665.95
2423.46
2423.46
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
EPO
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
HMO
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
Medicaid
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
Medicare Part A
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
Medicare Part B
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
POS
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
PPO
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30140
null
cpt
Removal of nasal air passage under the lining tissue
tricare
Workers Comp
O
29665.95
2423.46
3815.28
7799.50
17799.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
EPO
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
HMO
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
Medicaid
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
Medicare Part A
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
Medicare Part B
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
POS
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
PPO
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
303
null
ms-drg
atherosclerosis without mcc
va
Workers Comp
I
15661.54
4736.49
4736.49
4736.49
9396.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
EPO
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
HMO
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
Medicaid
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
POS
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
PPO
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
25869.36
5336.23
8610.51
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
EPO
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
HMO
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
Medicaid
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
Medicare Part A
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
Medicare Part B
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
POS
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
PPO
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
304
null
ms-drg
hypertension with mcc
united healthcare - medicare advantage
Workers Comp
I
25869.36
5336.23
5336.23
8610.51
15521.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
EPO
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
HMO
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
Medicaid
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
Medicare Part A
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
Medicare Part B
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
POS
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
PPO
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
blue cross blue shield
Workers Comp
I
17476.19
3964.42
7780.50
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
EPO
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
HMO
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
Medicaid
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
Medicare Part A
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
Medicare Part B
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
POS
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
PPO
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
cigna
Workers Comp
I
17476.19
3964.42
18810.66
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
EPO
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
HMO
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
Medicaid
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
Medicare Part A
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
Medicare Part B
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
POS
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
PPO
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
tricare
Workers Comp
I
17476.19
3964.42
3964.42
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
EPO
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
HMO
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
Medicaid
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
Medicare Part A
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
Medicare Part B
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
POS
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
PPO
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
united healthcare
Workers Comp
I
17476.19
3964.42
13381.81
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
EPO
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
HMO
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
Medicaid
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
Medicare Part A
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
Medicare Part B
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
POS
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
PPO
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
va
Workers Comp
I
17476.19
3964.42
5237.52
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
EPO
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
HMO
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
Medicaid
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
Medicare Part A
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
Medicare Part B
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
POS
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
PPO
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
305
null
ms-drg
hypertension without mcc
webtpa
Workers Comp
I
17476.19
3964.42
14050.94
18810.66
10485.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
EPO
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
HMO
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
Medicaid
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
Medicare Part A
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
Medicare Part B
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
POS
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
PPO
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
blue cross blue shield
Workers Comp
O
33510.81
3815.28
7799.50
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
EPO
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
HMO
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
Medicaid
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
Medicare Part A
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
Medicare Part B
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
POS
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
PPO
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30520
null
cpt
Reshaping of nasal cartilage
tricare
Workers Comp
O
33510.81
3815.28
3815.28
7799.50
20106.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
EPO
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
HMO
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
Medicaid
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
Medicare Part A
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
Medicare Part B
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
POS
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
PPO
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
blue cross blue shield
Workers Comp
I
24487.47
7794.82
13370.62
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
EPO
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
HMO
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
Medicaid
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
Medicare Part A
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
Medicare Part B
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
POS
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
PPO
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
humana - medicare advantage
Workers Comp
I
24487.47
7794.82
7794.82
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
EPO
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
HMO
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
Medicaid
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
Medicare Part A
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
Medicare Part B
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
POS
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
PPO
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
308
null
ms-drg
cardiac arrhythmia and conduction disorders with mcc
va
Workers Comp
I
24487.47
7794.82
8230.88
13370.62
14692.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
EPO
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
HMO
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
Medicaid
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
Medicare Part A
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
Medicare Part B
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
POS
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
PPO
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield
Workers Comp
I
18630.68
3702.16
6340.44
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
EPO
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
HMO
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
Medicaid
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
POS
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
PPO
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
blue cross blue shield - medicare advantage
Workers Comp
I
18630.68
3702.16
7330.88
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
EPO
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
HMO
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
Medicaid
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
Medicare Part A
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
Medicare Part B
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
POS
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
PPO
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
humana - medicare advantage
Workers Comp
I
18630.68
3702.16
4946.94
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
EPO
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
HMO
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
Medicaid
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
Medicare Part A
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
Medicare Part B
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
POS
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
PPO
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
tricare
Workers Comp
I
18630.68
3702.16
3702.16
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
EPO
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
HMO
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
Medicaid
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
Medicare Part A
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
Medicare Part B
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
POS
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
PPO
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
united healthcare - medicare advantage
Workers Comp
I
18630.68
3702.16
5320.18
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
EPO
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
HMO
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
Medicaid
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
Medicare Part A
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
Medicare Part B
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
POS
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
PPO
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
309
null
ms-drg
cardiac arrhythmia and conduction disorders with cc
webtpa
Workers Comp
I
18630.68
3702.16
9682.72
9682.72
11178.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
EPO
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
HMO
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
Medicaid
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
Medicare Part A
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
Medicare Part B
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
POS
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
PPO
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
30999
null
cpt
Nasal procedure
tricare
Workers Comp
O
39399.52
4819.51
4819.51
4819.51
23639.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
EPO
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
HMO
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
Medicaid
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
Medicare Part A
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
Medicare Part B
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
POS
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
PPO
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
blue cross blue shield
Workers Comp
I
16073.11
2923.72
6328.13
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
EPO
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
HMO
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
Medicaid
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
Medicare Part A
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
Medicare Part B
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
POS
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
PPO
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
humana - medicare advantage
Workers Comp
I
16073.11
2923.72
3449.71
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
EPO
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
HMO
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
Medicaid
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
Medicare Part A
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
Medicare Part B
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
POS
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
PPO
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
tricare
Workers Comp
I
16073.11
2923.72
2923.72
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
EPO
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
HMO
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
Medicaid
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
Medicare Part A
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
Medicare Part B
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
POS
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
PPO
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
va
Workers Comp
I
16073.11
2923.72
4344.80
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
EPO
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
HMO
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
Medicaid
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
Medicare Part A
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
Medicare Part B
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
POS
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
PPO
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
310
null
ms-drg
cardiac arrhythmia and conduction disorders without cc/mcc
webtpa
Workers Comp
I
16073.11
2923.72
11251.17
11251.17
9643.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
EPO
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
HMO
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
Medicaid
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
Medicare Part A
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
Medicare Part B
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
POS
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
PPO
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
blue cross blue shield
Workers Comp
I
19503.47
3986.02
7807.29
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
EPO
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
HMO
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
Medicaid
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
Medicare Part A
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
Medicare Part B
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
POS
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
PPO
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
312
null
ms-drg
syncope and collapse
humana - medicare advantage
Workers Comp
I
19503.47
3986.02
3986.02
7807.29
11702.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
EPO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
HMO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
Medicaid
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
Medicare Part A
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
Medicare Part B
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
POS
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
PPO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
blue cross blue shield
Workers Comp
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
EPO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
HMO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
Medicaid
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
Medicare Part A
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
Medicare Part B
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
POS
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
PPO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31254
null
cpt
Partial removal of nasal sinus using an endoscope
tricare
Workers Comp
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
EPO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
HMO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
Medicaid
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
Medicare Part A
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
Medicare Part B
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
POS
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
PPO
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
blue cross blue shield
Workers Comp
O
36487.97
4819.51
6790.97
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
EPO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
HMO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
Medicaid
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
Medicare Part A
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
Medicare Part B
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
POS
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
PPO
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31267
null
cpt
Removal of nasal sinus tissue using an endoscope maxillary sinus
tricare
Workers Comp
O
36487.97
4819.51
4819.51
6790.97
21892.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
EPO
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
HMO
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
Medicaid
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
Medicare Part A
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
Medicare Part B
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
POS
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
PPO
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
blue cross blue shield
Workers Comp
I
16996.95
4085.00
7902.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
EPO
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
HMO
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
Medicaid
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
Medicare Part A
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
Medicare Part B
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
POS
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
PPO
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
tricare
Workers Comp
I
16996.95
4085.00
4085.00
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
EPO
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
HMO
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
Medicaid
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
Medicare Part A
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
Medicare Part B
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
POS
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
PPO
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
313
null
ms-drg
chest pain
va
Workers Comp
I
16996.95
4085.00
5125.98
7902.00
10198.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
EPO
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
HMO
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
Medicaid
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
Medicare Part A
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
Medicare Part B
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
POS
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
PPO
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
aetna - medicare advantage
Workers Comp
I
49090.04
11056.67
12873.97
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
EPO
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
HMO
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
Medicaid
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
Medicare Part A
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
Medicare Part B
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
POS
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
PPO
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield
Workers Comp
I
49090.04
11056.67
21998.44
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
EPO
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
HMO
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
Medicaid
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
POS
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
PPO
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
49090.04
11056.67
16484.13
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
EPO
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
HMO
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
Medicaid
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
Medicare Part A
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
Medicare Part B
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
POS
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
PPO
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
314
null
ms-drg
other circulatory system diagnoses with mcc
humana - medicare advantage
Workers Comp
I
49090.04
11056.67
11056.67
21998.44
29454.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
EPO
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
HMO
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
Medicaid
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
Medicare Part A
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
Medicare Part B
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
POS
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
PPO
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
humana - medicare advantage
Workers Comp
I
19359.81
6098.97
6236.59
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
EPO
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
HMO
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
Medicaid
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
Medicare Part A
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
Medicare Part B
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
POS
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
PPO
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
315
null
ms-drg
other circulatory system diagnoses with cc
tricare
Workers Comp
I
19359.81
6098.97
6098.97
6236.59
11615.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
EPO
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
HMO
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
Medicaid
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
Medicare Part A
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
Medicare Part B
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
POS
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
PPO
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31536
null
cpt
Biopsy of voice box using an endoscope with operating microscope or telescope
humana - medicare advantage
Workers Comp
O
16357.89
2601.75
2601.75
2601.75
9814.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
EPO
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
HMO
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
Medicaid
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
Medicare Part A
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
Medicare Part B
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
POS
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
PPO
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31541
null
cpt
Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope
blue cross blue shield - medicare advantage
Workers Comp
O
20876.20
8797.66
8797.66
8797.66
12525.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
EPO
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
HMO
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
Medicaid
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
Medicare Part A
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
Medicare Part B
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
POS
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
PPO
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31575
null
cpt
Diagnostic examination of voice box using flexible endoscope
humana - medicare advantage
Workers Comp
O
207.48
320.10
320.10
320.10
124.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
EPO
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
HMO
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
Medicaid
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
Medicare Part A
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
Medicare Part B
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
POS
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
PPO
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31623
null
cpt
Examination of lung airways using an endoscope
blue cross blue shield
Workers Comp
O
16327.99
3680.85
3680.85
3680.85
9796.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
EPO
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
HMO
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
Medicaid
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
Medicare Part A
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
Medicare Part B
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
POS
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
PPO
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
blue cross blue shield
Workers Comp
O
17522.75
1267.35
3680.85
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
EPO
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
HMO
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
Medicaid
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
Medicare Part A
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
Medicare Part B
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
POS
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
PPO
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
31625
null
cpt
Biopsy of lung airways using an endoscope
humana - medicare advantage
Workers Comp
O
17522.75
1267.35
1267.35
3680.85
10513.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
EPO
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
HMO
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
Medicaid
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
Medicare Part A
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
Medicare Part B
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
POS
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
PPO
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32405
null
cpt
Needle biopsy of lung or chest tissue accessed through the skin
humana - medicare advantage
Workers Comp
O
9407.04
1215.96
1215.96
1215.96
5644.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
EPO
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
HMO
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
Medicaid
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
Medicare Part A
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
Medicare Part B
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
POS
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
PPO
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna
Workers Comp
O
2917.80
479.68
908.54
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
EPO
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
HMO
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
Medicaid
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
Medicare Part A
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
Medicare Part B
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
POS
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
PPO
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32555
null
cpt
Removal of fluid from chest cavity with imaging guidance
aetna - medicare advantage
Workers Comp
O
2917.80
479.68
479.68
908.54
1750.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
EPO
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
HMO
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
Medicaid
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
Medicare Part A
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
Medicare Part B
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
POS
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
PPO
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
32556
null
cpt
Removal of fluid from chest cavity with insertion of indwelling catheter accessed through the skin
humana - medicare advantage
Workers Comp
O
20722.79
1439.18
1439.18
1439.18
12433.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
EPO
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
HMO
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
Medicaid
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
Medicare Part A
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
Medicare Part B
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
POS
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
PPO
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
cigna
Workers Comp
I
138722.39
30301.35
288925.38
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
EPO
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
HMO
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
Medicaid
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
Medicare Part A
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
Medicare Part B
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
POS
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
PPO
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
326
null
ms-drg
stomach esophageal and duodenal procedures with mcc
tricare
Workers Comp
I
138722.39
30301.35
30301.35
288925.38
83233.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
EPO
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
HMO
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
Medicaid
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
POS
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
PPO
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
47097.87
8796.95
8796.95
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
EPO
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
HMO
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
Medicaid
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
Medicare Part A
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
Medicare Part B
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
POS
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
PPO
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
328
null
ms-drg
stomach esophageal and duodenal procedures without cc/mcc
tricare
Workers Comp
I
47097.87
8796.95
10966.09
10966.09
28258.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
EPO
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
HMO
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
Medicaid
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
Medicare Part A
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
Medicare Part B
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
POS
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
PPO
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
329
null
ms-drg
major small and large bowel procedures with mcc
humana - medicare advantage
Workers Comp
I
98166.33
28383.62
28383.62
28383.62
58899.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
EPO
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
HMO
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
Medicaid
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
Medicare Part A
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
Medicare Part B
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
POS
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
PPO
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield
Workers Comp
I
57763.90
15325.30
23610.09
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
EPO
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
HMO
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
POS
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
PPO
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
57763.90
15325.30
27775.13
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
EPO
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
HMO
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
Medicaid
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
Medicare Part A
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
Medicare Part B
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
POS
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
PPO
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
humana - medicare advantage
Workers Comp
I
57763.90
15325.30
15325.30
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
EPO
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
HMO
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
Medicaid
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
Medicare Part A
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
Medicare Part B
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
POS
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
PPO
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
tricare
Workers Comp
I
57763.90
15325.30
15700.60
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
EPO
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
HMO
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
Medicaid
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
Medicare Part A
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
Medicare Part B
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
POS
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
PPO
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
united healthcare
Workers Comp
I
57763.90
15325.30
59746.02
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
EPO
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
HMO
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
Medicaid
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
Medicare Part A
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
Medicare Part B
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
POS
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
PPO
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
330
null
ms-drg
major small and large bowel procedures with cc
webtpa
Workers Comp
I
57763.90
15325.30
32467.31
59746.02
34658.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
EPO
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
HMO
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
Medicaid
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
POS
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
PPO
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield
Workers Comp
I
53221.41
10527.07
15539.62
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
POS
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
53221.41
10527.07
13763.35
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
EPO
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
HMO
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
Medicaid
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
POS
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
PPO
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
53221.41
10527.07
10527.07
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
EPO
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
HMO
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
Medicaid
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
Medicare Part A
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
Medicare Part B
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
POS
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
PPO
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
331
null
ms-drg
major small and large bowel procedures without cc/mcc
tricare
Workers Comp
I
53221.41
10527.07
11275.55
15539.62
31932.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
EPO
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
HMO
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
Medicaid
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
Medicare Part A
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
Medicare Part B
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
POS
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
PPO
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33207
null
cpt
Insertion or replacement of permanent pacemaker and lower chamber electrodes
humana - medicare advantage
Workers Comp
O
39518.80
9081.99
9081.99
9081.99
23711.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
EPO
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
HMO
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
Medicaid
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
Medicare Part A
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
Medicare Part B
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
POS
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
PPO
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
aetna - medicare advantage
Workers Comp
O
38454.97
8434.35
8434.35
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
EPO
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
HMO
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
Medicaid
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
Medicare Part A
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
Medicare Part B
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
POS
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
PPO
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
humana - medicare advantage
Workers Comp
O
38454.97
8434.35
9146.39
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
EPO
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
HMO
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
Medicaid
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
Medicare Part A
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
Medicare Part B
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
POS
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
PPO
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33208
null
cpt
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes
va
Workers Comp
O
38454.97
8434.35
9210.48
9210.48
23072.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
EPO
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
HMO
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
Medicaid
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
Medicare Part A
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
Medicare Part B
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
POS
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
PPO
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33215
null
cpt
Repositioning of implanted pacemaker or defibrillator device
aetna - medicare advantage
Workers Comp
O
18165.01
2534.40
2534.40
2534.40
10899.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
EPO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
HMO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
Medicaid
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
Medicare Part A
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
Medicare Part B
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
POS
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
PPO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33221
null
cpt
Insertion of pacemaker pulse generator with existing multiple leads
humana - medicare advantage
Workers Comp
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
EPO
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
HMO
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
Medicaid
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part A
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part B
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
POS
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
PPO
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33227
null
cpt
Removal and replacement of single lead permanent pacemaker pulse generator
humana - medicare advantage
Workers Comp
O
25507.27
6769.76
6769.76
6769.76
15304.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
EPO
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
HMO
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
Medicaid
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
Medicare Part A
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
Medicare Part B
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
POS
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
PPO
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
blue cross blue shield
Workers Comp
O
31780.71
8519.55
9302.90
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
EPO
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
HMO
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
Medicaid
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part A
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part B
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
POS
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
PPO
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
humana - medicare advantage
Workers Comp
O
31780.71
8519.55
9210.79
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
EPO
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
HMO
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
Medicaid
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
Medicare Part A
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
Medicare Part B
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
POS
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
PPO
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33228
null
cpt
Removal and replacement of dual lead permanent pacemaker pulse generator
tricare
Workers Comp
O
31780.71
8519.55
8519.55
9302.90
19068.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
EPO
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
HMO
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
Medicaid
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part A
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
Medicare Part B
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
POS
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
PPO
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33229
null
cpt
Removal and replacement of multiple lead permanent pacemaker pulse generator
humana - medicare advantage
Workers Comp
O
21790.52
16223.32
16223.32
16223.32
13074.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
EPO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
HMO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
Medicaid
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
Medicare Part A
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
Medicare Part B
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
POS
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
PPO
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33241
null
cpt
Removal of defibrillator pulse generator
humana - medicare advantage
Workers Comp
O
42160.56
16482.88
16482.88
16482.88
25296.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
EPO
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
HMO
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
Medicaid
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
Medicare Part A
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
Medicare Part B
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
POS
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
PPO
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
blue cross blue shield
Workers Comp
O
100724.82
28598.55
38749.05
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
EPO
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
HMO
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
Medicaid
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
Medicare Part A
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
Medicare Part B
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
POS
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
PPO
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33249
null
cpt
Insertion or replacement of single or dual chamber pacing defibrillator leads
humana - medicare advantage
Workers Comp
O
100724.82
28598.55
28598.55
38749.05
60434.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
EPO
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
HMO
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
Medicaid
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
Medicare Part A
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
Medicare Part B
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
POS
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
PPO
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33262
null
cpt
Removal and replacement of defibrillator pulse generator single wire (lead)
aetna
Workers Comp
O
77301.81
30118.22
30118.22
30118.22
46381.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
EPO
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
HMO
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
Medicaid
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
Medicare Part A
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
Medicare Part B
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
POS
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
PPO
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
blue cross blue shield
Workers Comp
O
84317.64
29082.45
43115.26
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
EPO
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
HMO
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
Medicaid
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
Medicare Part A
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
Medicare Part B
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
POS
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
PPO
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33264
null
cpt
Removal and replacement of defibrillator pulse generator multiple wires (leads)
va
Workers Comp
O
84317.64
29082.45
29082.45
43115.26
50590.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
EPO
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
HMO
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
Medicaid
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
Medicare Part A
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
Medicare Part B
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
POS
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
PPO
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33285
null
cpt
Insertion of heart rhythm monitor under skin
va
Workers Comp
O
23173.35
7220.01
7220.01
7220.01
13904.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
EPO
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
HMO
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
Medicaid
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
Medicare Part A
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
Medicare Part B
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
POS
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
PPO
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33286
null
cpt
Removal of heart rhythm monitor from under skin
tricare
Workers Comp
O
49348.83
550.84
550.84
550.84
29609.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
EPO
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
HMO
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
Medicaid
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
Medicare Part A
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
Medicare Part B
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
POS
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
PPO
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
33430
null
cpt
Replacement of valve between left upper and lower chambers on heart-lung machine
aetna
Workers Comp
I
207801.54
46497.02
46497.02
46497.02
124680.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
EPO
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
HMO
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
Medicaid
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
Medicare Part A
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
Medicare Part B
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
POS
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
PPO
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
blue cross blue shield
Workers Comp
I
79845.16
11173.36
30215.29
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
EPO
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
HMO
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
Medicaid
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
Medicare Part A
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
Medicare Part B
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
POS
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
PPO
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
humana - medicare advantage
Workers Comp
I
79845.16
11173.36
12739.24
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
EPO
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
HMO
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
Medicaid
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
Medicare Part A
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
Medicare Part B
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
POS
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
PPO
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
336
null
ms-drg
peritoneal adhesiolysis with cc
tricare
Workers Comp
I
79845.16
11173.36
11173.36
30215.29
47907.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
EPO
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
HMO
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
Medicaid
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
Medicare Part A
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
Medicare Part B
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
POS
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
PPO
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield
Workers Comp
I
48274.85
18204.75
18204.75
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
POS
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
48274.85
18204.75
18659.46
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
EPO
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
HMO
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
Medicaid
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
Medicare Part A
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
Medicare Part B
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
POS
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
PPO
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
337
null
ms-drg
peritoneal adhesiolysis without cc/mcc
united healthcare
Workers Comp
I
48274.85
18204.75
38438.58
38438.58
28964.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
EPO
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
HMO
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
Medicaid
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
Medicare Part A
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
Medicare Part B
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
POS
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
PPO
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
339
null
ms-drg
appendectomy with complicated principal diagnosis with cc
tricare
Workers Comp
I
50494.09
8877.02
8877.02
8877.02
30296.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
EPO
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
HMO
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicaid
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part A
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part B
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
POS
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
PPO
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
340
null
ms-drg
appendectomy with complicated principal diagnosis without cc/mcc
blue cross blue shield
Workers Comp
I
35633.04
12761.51
12761.51
12761.51
21379.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
EPO
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
HMO
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
Medicaid
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
Medicare Part A
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
Medicare Part B
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
POS
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
PPO
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
341
null
ms-drg
appendectomy without complicated principal diagnosis with mcc
tricare
Workers Comp
I
40770.71
9375.78
9375.78
9375.78
24462.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
EPO
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
HMO
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
Medicaid
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
Medicare Part A
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
Medicare Part B
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
POS
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
PPO
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
342
null
ms-drg
appendectomy without complicated principal diagnosis with cc
tricare
Workers Comp
I
28076.04
8397.82
8397.82
8397.82
16845.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
EPO
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
HMO
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicaid
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part A
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part B
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
POS
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
PPO
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield
Workers Comp
I
32776.35
6538.67
9677.23
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
POS
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
32776.35
6538.67
12173.28
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
EPO
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
HMO
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
Medicaid
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
Medicare Part A
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
Medicare Part B
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
POS
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
PPO
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
343
null
ms-drg
appendectomy without complicated principal diagnosis without cc/mcc
tricare
Workers Comp
I
32776.35
6538.67
6538.67
12173.28
19665.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
EPO
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
HMO
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
Medicaid
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
POS
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
PPO
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield
Workers Comp
I
32679.20
10525.99
10525.99
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
POS
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
346
null
ms-drg
minor small and large bowel procedures without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
32679.20
10525.99
12647.52
12647.52
19607.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
EPO
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
HMO
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
Medicaid
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
Medicare Part A
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
Medicare Part B
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
POS
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
PPO
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
348
null
ms-drg
anal and stomal procedures with cc
blue cross blue shield
Workers Comp
I
33439.95
8991.14
8991.14
8991.14
20063.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
EPO
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
HMO
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
Medicaid
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
Medicare Part A
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
Medicare Part B
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
POS
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
PPO
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
va
Workers Comp
I
43651.62
10245.37
10245.37
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
EPO
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
HMO
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
Medicaid
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
Medicare Part A
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
Medicare Part B
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
POS
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
PPO
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
351
null
ms-drg
inguinal and femoral hernia procedures with cc
webtpa
Workers Comp
I
43651.62
10245.37
51566.74
51566.74
26190.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
EPO
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
HMO
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
Medicaid
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
Medicare Part A
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
Medicare Part B
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
POS
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
PPO
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
blue cross blue shield
Workers Comp
I
52930.66
9279.67
16343.79
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
EPO
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
HMO
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
Medicaid
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
Medicare Part A
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
Medicare Part B
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
POS
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
PPO
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
354
null
ms-drg
hernia procedures except inguinal and femoral with cc
humana - medicare advantage
Workers Comp
I
52930.66
9279.67
9279.67
16343.79
31758.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
EPO
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
HMO
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
Medicaid
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
Medicare Part A
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
Medicare Part B
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
POS
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
PPO
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
355
null
ms-drg
hernia procedures except inguinal and femoral without cc/mcc
tricare
Workers Comp
I
55123.09
9838.77
9838.77
9838.77
33073.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
EPO
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
HMO
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
Medicaid
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
Medicare Part A
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
Medicare Part B
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
POS
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
PPO
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
357
null
ms-drg
other digestive system o.r. procedures with cc
blue cross blue shield
Workers Comp
I
46116.62
18666.46
18666.46
18666.46
27669.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
EPO
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
HMO
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
Medicaid
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
Medicare Part A
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
Medicare Part B
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
POS
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
PPO
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna
Workers Comp
I
74807.00
11699.02
21001.66
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
EPO
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
HMO
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
Medicaid
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
Medicare Part A
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
Medicare Part B
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
POS
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
PPO
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36010
null
cpt
Introduction of catheter into the upper or lower major vein (vena cava)
aetna - medicare advantage
Workers Comp
I
74807.00
11699.02
11699.02
21001.66
44884.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
EPO
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
HMO
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
Medicaid
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
Medicare Part A
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
Medicare Part B
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
POS
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
PPO
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36200
null
cpt
Insertion of catheter into aorta
va
Workers Comp
O
23684.59
2534.31
2534.31
2534.31
14210.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
EPO
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
HMO
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
Medicaid
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
Medicare Part A
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
Medicare Part B
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
POS
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
PPO
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36217
null
cpt
Insertion of catheter into chest or arm artery initial third order branch
humana - medicare advantage
Workers Comp
O
23718.72
2534.40
2534.40
2534.40
14231.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
EPO
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
HMO
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
Medicaid
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
Medicare Part A
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
Medicare Part B
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
POS
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
PPO
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
aetna - medicare advantage
Workers Comp
O
20677.46
3402.86
4013.59
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
EPO
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
HMO
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
POS
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
PPO
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36223
null
cpt
Insertion of catheter into intracranial artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
20677.46
3402.86
3402.86
4013.59
12406.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
EPO
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
HMO
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
Medicaid
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
Medicare Part A
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
Medicare Part B
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
POS
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
PPO
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36225
null
cpt
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation
blue cross blue shield
Workers Comp
O
20967.00
5763.06
5763.06
5763.06
12580.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
EPO
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
HMO
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
POS
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
PPO
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36226
null
cpt
Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
37531.14
2567.49
2567.49
2567.49
22518.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
EPO
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
HMO
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
Medicaid
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
Medicare Part A
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
Medicare Part B
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
POS
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
PPO
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield
Workers Comp
O
21813.44
2455.02
4666.10
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
EPO
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
HMO
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
Medicaid
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
Medicare Part A
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
Medicare Part B
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
POS
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
PPO
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
blue cross blue shield - medicare advantage
Workers Comp
O
21813.44
2455.02
4348.92
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
EPO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
HMO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
Medicaid
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
Medicare Part A
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
Medicare Part B
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
POS
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
PPO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
humana - medicare advantage
Workers Comp
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
EPO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
HMO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
Medicaid
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
Medicare Part A
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
Medicare Part B
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
POS
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
PPO
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
tricare
Workers Comp
O
21813.44
2455.02
2455.02
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
EPO
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
HMO
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
Medicaid
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
Medicare Part A
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
Medicare Part B
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
POS
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
PPO
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36245
null
cpt
Insertion of catheter into abdominal pelvic or leg artery each first order branch
va
Workers Comp
O
21813.44
2455.02
2534.31
4666.10
13088.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
EPO
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
HMO
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
Medicaid
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
Medicare Part A
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
Medicare Part B
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
POS
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
PPO
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
humana - medicare advantage
Workers Comp
O
22196.13
2455.02
2534.40
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
EPO
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
HMO
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
Medicaid
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
Medicare Part A
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
Medicare Part B
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
POS
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
PPO
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
tricare
Workers Comp
O
22196.13
2455.02
2455.02
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
EPO
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
HMO
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
Medicaid
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
Medicare Part A
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
Medicare Part B
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
POS
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
PPO
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36246
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial second order branch
va
Workers Comp
O
22196.13
2455.02
2534.31
2534.40
13317.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
EPO
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
HMO
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
Medicaid
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
Medicare Part A
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
Medicare Part B
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
POS
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
PPO
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36247
null
cpt
Insertion of catheter into abdominal pelvic or leg artery initial third order branch
tricare
Workers Comp
O
23833.42
2455.02
2455.02
2455.02
14300.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
EPO
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
HMO
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
POS
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
PPO
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36251
null
cpt
Selective insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
38149.31
14226.92
14226.92
14226.92
22889.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
EPO
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
HMO
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicaid
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part A
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part B
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
POS
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
PPO
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36252
null
cpt
Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Workers Comp
O
13172.14
4348.92
4348.92
4348.92
7903.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
EPO
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
HMO
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
Medicaid
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
Medicare Part A
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
Medicare Part B
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
POS
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
PPO
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36410
null
cpt
Insertion of needle into vein patient 3 years or older
humana - medicare advantage
Workers Comp
O
5031.10
1156.59
1156.59
1156.59
3018.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
aetna - medicare advantage
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
EPO
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
HMO
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
Medicaid
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
Medicare Part A
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
Medicare Part B
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
POS
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
PPO
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield
Workers Comp
O
27.82
3.00
5.71
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
EPO
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
HMO
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
Medicaid
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
Medicare Part A
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
Medicare Part B
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
POS
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
PPO
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
blue cross blue shield - medicare advantage
Workers Comp
O
27.82
3.00
5.56
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
EPO
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
HMO
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
Medicaid
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
Medicare Part A
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
Medicare Part B
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
POS
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
PPO
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
cigna
Workers Comp
O
27.82
3.00
19.69
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
EPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
HMO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
Medicaid
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
Medicare Part A
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
Medicare Part B
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
POS
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
PPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
geha
Workers Comp
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
EPO
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
HMO
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
Medicaid
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
Medicare Part A
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
Medicare Part B
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
POS
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
PPO
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
healthchoice
Workers Comp
O
27.82
3.00
6.59
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
EPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
HMO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
Medicaid
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
Medicare Part A
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
Medicare Part B
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
POS
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
PPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana
Workers Comp
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
humana - medicare advantage
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
EPO
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
HMO
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
Medicaid
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
Medicare Part A
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
Medicare Part B
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
POS
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
PPO
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
medica
Workers Comp
O
27.82
3.00
10.29
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
tricare
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
EPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
HMO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
Medicaid
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
Medicare Part A
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
Medicare Part B
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
POS
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
PPO
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare
Workers Comp
O
27.82
3.00
19.88
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
united healthcare - medicare advantage
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
EPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
HMO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
Medicaid
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
Medicare Part A
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
Medicare Part B
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
POS
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
PPO
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
va
Workers Comp
O
27.82
3.00
3.00
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
EPO
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
HMO
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
Medicaid
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
Medicare Part A
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
Medicare Part B
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
POS
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
PPO
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
webtpa
Workers Comp
O
27.82
3.00
18.55
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
EPO
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
HMO
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
Medicaid
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
Medicare Part A
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
Medicare Part B
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
POS
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
PPO
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36415
null
cpt
Insertion of needle into vein for collection of blood sample
worker comp
Workers Comp
O
27.82
3.00
19.87
19.88
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
EPO
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
HMO
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
Medicaid
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
Medicare Part A
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
Medicare Part B
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
POS
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
PPO
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield
Workers Comp
O
11.13
2.68
2.69
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
EPO
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
HMO
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
Medicaid
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
Medicare Part A
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
Medicare Part B
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
POS
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
PPO
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
blue cross blue shield - medicare advantage
Workers Comp
O
11.13
2.68
2.68
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
EPO
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
HMO
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
Medicaid
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
Medicare Part A
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
Medicare Part B
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
POS
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
PPO
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
humana - medicare advantage
Workers Comp
O
11.13
2.68
4.97
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
EPO
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
HMO
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
Medicaid
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
Medicare Part A
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
Medicare Part B
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
POS
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
PPO
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
united healthcare
Workers Comp
O
11.13
2.68
8.35
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
EPO
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
HMO
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
Medicaid
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
Medicare Part A
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
Medicare Part B
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
POS
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
PPO
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36416
null
cpt
Puncture of skin for collection of blood sample
worker comp
Workers Comp
O
11.13
2.68
7.95
8.35
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
EPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
HMO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
Medicaid
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
Medicare Part A
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
Medicare Part B
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
POS
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
PPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna
Workers Comp
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
EPO
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
HMO
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
Medicaid
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
Medicare Part A
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
Medicare Part B
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
POS
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
PPO
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
aetna - medicare advantage
Workers Comp
O
463.00
280.77
351.65
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
EPO
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
HMO
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
Medicaid
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
Medicare Part A
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
Medicare Part B
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
POS
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
PPO
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield
Workers Comp
O
463.00
280.77
287.07
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
EPO
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
HMO
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
Medicaid
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
Medicare Part A
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
Medicare Part B
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
POS
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
PPO
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
blue cross blue shield - medicare advantage
Workers Comp
O
463.00
280.77
280.77
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
EPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
HMO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
Medicaid
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
Medicare Part A
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
Medicare Part B
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
POS
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
PPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
humana - medicare advantage
Workers Comp
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
EPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
HMO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
Medicaid
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
Medicare Part A
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
Medicare Part B
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
POS
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
PPO
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
tricare
Workers Comp
O
463.00
280.77
343.76
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
EPO
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
HMO
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
Medicaid
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
Medicare Part A
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
Medicare Part B
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
POS
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
PPO
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
united healthcare
Workers Comp
O
463.00
280.77
347.25
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
EPO
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
HMO
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
Medicaid
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
Medicare Part A
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
Medicare Part B
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
POS
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
PPO
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36430
null
cpt
Transfusion of blood or blood products
va
Workers Comp
O
463.00
280.77
351.64
351.65
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
EPO
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
HMO
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
Medicaid
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
Medicare Part A
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
Medicare Part B
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
POS
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
PPO
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
blue cross blue shield
Workers Comp
O
1761.60
2494.71
12086.89
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
EPO
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
HMO
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
Medicaid
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
Medicare Part A
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
Medicare Part B
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
POS
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
PPO
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36471
null
cpt
Injection of chemical agent into multiple incompetent veins of one leg
tricare
Workers Comp
O
1761.60
2494.71
2494.71
12086.89
1056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
EPO
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
HMO
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
Medicaid
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
Medicare Part A
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
Medicare Part B
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
POS
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
PPO
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
blue cross blue shield
Workers Comp
O
21706.60
2455.02
12086.89
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
EPO
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
HMO
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
Medicaid
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
Medicare Part A
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
Medicare Part B
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
POS
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
PPO
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
cigna
Workers Comp
O
21706.60
2455.02
16128.00
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
EPO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
HMO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
Medicaid
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
Medicare Part A
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
Medicare Part B
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
POS
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
PPO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
humana - medicare advantage
Workers Comp
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
EPO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
HMO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
Medicaid
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
Medicare Part A
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
Medicare Part B
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
POS
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
PPO
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36475
null
cpt
Destruction of insufficient vein of arm or leg accessed through the skin
tricare
Workers Comp
O
21706.60
2455.02
2455.02
16128.00
13023.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
EPO
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
HMO
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
Medicaid
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
Medicare Part A
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
Medicare Part B
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
POS
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
PPO
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
blue cross blue shield - medicare advantage
Workers Comp
O
16795.13
2534.31
8160.59
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
EPO
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
HMO
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
Medicaid
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
Medicare Part A
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
Medicare Part B
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
POS
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
PPO
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36556
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older not tunneled
va
Workers Comp
O
16795.13
2534.31
2534.31
8160.59
10077.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
EPO
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
HMO
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
Medicaid
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
Medicare Part A
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
Medicare Part B
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
POS
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
PPO
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield
Workers Comp
O
18465.72
2494.71
4745.30
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
EPO
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
HMO
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
Medicaid
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
Medicare Part A
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
Medicare Part B
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
POS
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
PPO
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
blue cross blue shield - medicare advantage
Workers Comp
O
18465.72
2494.71
4820.22
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
EPO
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
HMO
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
Medicaid
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
Medicare Part A
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
Medicare Part B
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
POS
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
PPO
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36558
null
cpt
Insertion of central venous catheter for infusion patient 5 years or older tunneled
humana - medicare advantage
Workers Comp
O
18465.72
2494.71
2494.71
4820.22
11079.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
EPO
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
HMO
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
Medicaid
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
Medicare Part A
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
Medicare Part B
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
POS
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
PPO
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna
Workers Comp
O
17112.95
2432.93
6432.20
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
EPO
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
HMO
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
Medicaid
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
Medicare Part A
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
Medicare Part B
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
POS
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
PPO
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
aetna - medicare advantage
Workers Comp
O
17112.95
2432.93
2432.93
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
EPO
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
HMO
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
Medicaid
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
Medicare Part A
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
Medicare Part B
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
POS
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
PPO
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield
Workers Comp
O
17112.95
2432.93
5148.79
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
EPO
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
HMO
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
Medicaid
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
Medicare Part A
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
Medicare Part B
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
POS
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
PPO
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
blue cross blue shield - medicare advantage
Workers Comp
O
17112.95
2432.93
4407.51
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
EPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
HMO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
Medicaid
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
Medicare Part A
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
Medicare Part B
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
POS
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
PPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
humana - medicare advantage
Workers Comp
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
EPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
HMO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
Medicaid
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
Medicare Part A
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
Medicare Part B
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
POS
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
PPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
tricare
Workers Comp
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
EPO
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
HMO
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
Medicaid
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
Medicare Part A
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
Medicare Part B
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
POS
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
PPO
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare
Workers Comp
O
17112.95
2432.93
12335.28
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
EPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
HMO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
Medicaid
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
Medicare Part A
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
Medicare Part B
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
POS
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
PPO
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
united healthcare - medicare advantage
Workers Comp
O
17112.95
2432.93
2455.02
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
EPO
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
HMO
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
Medicaid
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
Medicare Part A
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
Medicare Part B
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
POS
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
PPO
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36561
null
cpt
Insertion of central venous catheter and implanted device for infusion beneath the skin patient 5 years or older
va
Workers Comp
O
17112.95
2432.93
2534.31
12335.28
10267.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
EPO
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
HMO
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
Medicaid
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
Medicare Part A
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
Medicare Part B
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
POS
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
PPO
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
blue cross blue shield
Workers Comp
O
2539.67
1421.87
6010.28
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
EPO
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
HMO
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
Medicaid
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
Medicare Part A
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
Medicare Part B
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
POS
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
PPO
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36569
null
cpt
Insertion of peripherally inserted central venous catheter for infusion (PICC) patient 5 years or older
humana - medicare advantage
Workers Comp
O
2539.67
1421.87
1421.87
6010.28
1523.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
EPO
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
HMO
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
Medicaid
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
Medicare Part A
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
Medicare Part B
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
POS
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
PPO
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36581
null
cpt
Replacement of central venous catheter tunneled without port or pump
humana - medicare advantage
Workers Comp
O
17618.81
2455.02
2455.02
2455.02
10571.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
EPO
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
HMO
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
Medicaid
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
Medicare Part A
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
Medicare Part B
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
POS
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
PPO
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
blue cross blue shield - medicare advantage
Workers Comp
O
1051.52
2455.02
6273.93
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
EPO
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
HMO
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
Medicaid
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
Medicare Part A
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
Medicare Part B
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
POS
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
PPO
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
humana - medicare advantage
Workers Comp
O
1051.52
2455.02
2455.02
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
EPO
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
HMO
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
Medicaid
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
Medicare Part A
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
Medicare Part B
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
POS
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
PPO
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36589
null
cpt
Removal of central venous catheter for infusion
va
Workers Comp
O
1051.52
2455.02
2469.84
6273.93
630.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
EPO
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
HMO
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
Medicaid
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
Medicare Part A
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
Medicare Part B
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
POS
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
PPO
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna
Workers Comp
O
1695.60
588.40
671.39
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
EPO
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
HMO
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
Medicaid
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
Medicare Part A
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
Medicare Part B
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
POS
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
PPO
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
aetna - medicare advantage
Workers Comp
O
1695.60
588.40
2410.83
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
EPO
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
HMO
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
Medicaid
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
Medicare Part A
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
Medicare Part B
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
POS
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
PPO
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
humana - medicare advantage
Workers Comp
O
1695.60
588.40
2241.27
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
EPO
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
HMO
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
Medicaid
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
Medicare Part A
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
Medicare Part B
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
POS
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
PPO
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36590
null
cpt
Removal of peripheral venous catheter for infusion
tricare
Workers Comp
O
1695.60
588.40
588.40
2410.83
1017.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
EPO
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
HMO
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
Medicaid
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
Medicare Part A
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
Medicare Part B
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
POS
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
PPO
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
blue cross blue shield
Workers Comp
O
172.23
13.59
13.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
EPO
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
HMO
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
Medicaid
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
Medicare Part A
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
Medicare Part B
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
POS
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
PPO
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36591
null
cpt
Collection of blood specimen from a completely implantable venous access device
humana - medicare advantage
Workers Comp
O
172.23
13.59
96.59
96.59
103.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
EPO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
HMO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
Medicaid
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
Medicare Part A
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
Medicare Part B
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
POS
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
PPO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna
Workers Comp
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
EPO
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
HMO
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
Medicaid
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
Medicare Part A
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
Medicare Part B
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
POS
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
PPO
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
aetna - medicare advantage
Workers Comp
O
160.27
23.30
99.15
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
EPO
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
HMO
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
Medicaid
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
Medicare Part A
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
Medicare Part B
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
POS
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
PPO
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield
Workers Comp
O
160.27
23.30
23.30
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
EPO
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
HMO
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
Medicaid
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
Medicare Part A
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
Medicare Part B
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
POS
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
PPO
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
blue cross blue shield - medicare advantage
Workers Comp
O
160.27
23.30
27.40
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
EPO
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
HMO
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
Medicaid
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
Medicare Part A
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
Medicare Part B
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
POS
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
PPO
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
cigna
Workers Comp
O
160.27
23.30
111.05
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
EPO
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
HMO
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
Medicaid
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
Medicare Part A
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
Medicare Part B
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
POS
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
PPO
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
humana - medicare advantage
Workers Comp
O
160.27
23.30
97.87
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
EPO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
HMO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
Medicaid
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
Medicare Part A
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
Medicare Part B
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
POS
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
PPO
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
tricare
Workers Comp
O
160.27
23.30
96.59
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
EPO
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
HMO
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
Medicaid
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
Medicare Part A
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
Medicare Part B
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
POS
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
PPO
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36592
null
cpt
Collection of blood specimen from central or peripheral venous catheter
united healthcare
Workers Comp
O
160.27
23.30
112.10
112.10
96.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
EPO
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
HMO
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
Medicaid
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
Medicare Part A
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
Medicare Part B
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
POS
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
PPO
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna
Workers Comp
O
17770.86
274.27
4740.84
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
EPO
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
EPO
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
HMO
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
HMO
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicaid
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicaid
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicare Part A
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicare Part A
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicare Part B
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Medicare Part B
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
POS
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
POS
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
PPO
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
PPO
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Workers Comp
I
40598.60
5931.05
5931.05
5931.05
24359.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
aetna - medicare advantage
Workers Comp
O
17770.86
274.27
274.27
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
EPO
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
HMO
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
Medicaid
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
Medicare Part A
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
Medicare Part B
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
POS
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
PPO
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
blue cross blue shield
Workers Comp
O
17770.86
274.27
2049.15
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
EPO
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
HMO
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
Medicaid
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
Medicare Part A
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
Medicare Part B
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
POS
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
PPO
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
humana - medicare advantage
Workers Comp
O
17770.86
274.27
5750.70
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
EPO
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
HMO
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
Medicaid
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
Medicare Part A
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
Medicare Part B
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
POS
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
PPO
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
tricare
Workers Comp
O
17770.86
274.27
8371.66
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
EPO
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
HMO
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
Medicaid
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
Medicare Part A
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
Medicare Part B
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
POS
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
PPO
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36593
null
cpt
Declotting infusion of implanted central venous access device or catheter
united healthcare
Workers Comp
O
17770.86
274.27
7814.07
8371.66
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
EPO
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
HMO
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
Medicaid
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
Medicare Part A
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
Medicare Part B
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
POS
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
PPO
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36598
null
cpt
Contrast injections for X-ray imaging procedure to evaluate central venous access device
humana - medicare advantage
Workers Comp
O
1114.80
153.48
153.48
153.48
668.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
EPO
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
HMO
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
Medicaid
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
Medicare Part A
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
Medicare Part B
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
POS
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
PPO
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna
Workers Comp
O
169.17
34.31
147.18
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
EPO
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
HMO
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
Medicaid
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
Medicare Part A
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
Medicare Part B
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
POS
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
PPO
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
aetna - medicare advantage
Workers Comp
O
169.17
34.31
96.59
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
EPO
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
HMO
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
Medicaid
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
Medicare Part A
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
Medicare Part B
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
POS
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
PPO
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield
Workers Comp
O
169.17
34.31
34.31
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
EPO
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
HMO
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
Medicaid
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
Medicare Part A
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
Medicare Part B
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
POS
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
PPO
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
blue cross blue shield - medicare advantage
Workers Comp
O
169.17
34.31
34.88
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
EPO
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
HMO
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
Medicaid
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
Medicare Part A
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
Medicare Part B
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
POS
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
PPO
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
tricare
Workers Comp
O
169.17
34.31
99.15
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
EPO
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
HMO
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
Medicaid
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
Medicare Part A
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
Medicare Part B
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
POS
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
PPO
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36600
null
cpt
Arterial puncture withdrawal of blood for diagnosis
united healthcare
Workers Comp
O
169.17
34.31
120.84
147.18
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
EPO
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
HMO
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
Medicaid
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
Medicare Part A
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
Medicare Part B
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
POS
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
PPO
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
blue cross blue shield
Workers Comp
I
23928.63
9698.69
9698.69
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
EPO
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
HMO
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
Medicaid
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
Medicare Part A
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
Medicare Part B
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
POS
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
PPO
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
368
null
ms-drg
major esophageal disorders with mcc
humana - medicare advantage
Workers Comp
I
23928.63
9698.69
11887.75
11887.75
14357.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
EPO
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
HMO
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
Medicaid
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
Medicare Part A
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
Medicare Part B
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
POS
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
PPO
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield
Workers Comp
O
18000.28
4224.83
7953.76
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
EPO
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
HMO
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
Medicaid
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
Medicare Part A
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
Medicare Part B
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
POS
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
PPO
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
blue cross blue shield - medicare advantage
Workers Comp
O
18000.28
4224.83
7221.58
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
EPO
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
HMO
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
Medicaid
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
Medicare Part A
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
Medicare Part B
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
POS
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
PPO
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36818
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm cephalic vein
humana - medicare advantage
Workers Comp
O
18000.28
4224.83
4224.83
7953.76
10800.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
EPO
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
HMO
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
Medicaid
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
Medicare Part A
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
Medicare Part B
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
POS
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
PPO
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36819
null
cpt
Relocation of arm vein with connection to arm artery open procedure upper arm basilic vein
humana - medicare advantage
Workers Comp
O
22196.01
4224.83
4224.83
4224.83
13317.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
EPO
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
HMO
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
Medicaid
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
Medicare Part A
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
Medicare Part B
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
POS
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
PPO
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
aetna
Workers Comp
O
17351.65
2534.40
5891.47
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
EPO
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
HMO
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
Medicaid
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
Medicare Part A
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
Medicare Part B
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
POS
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
PPO
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
blue cross blue shield
Workers Comp
O
17351.65
2534.40
10220.11
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
EPO
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
HMO
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
Medicaid
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
Medicare Part A
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
Medicare Part B
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
POS
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
PPO
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36821
null
cpt
Relocation of arm vein with connection to arm artery open procedure any site as separate procedure
humana - medicare advantage
Workers Comp
O
17351.65
2534.40
2534.40
10220.11
10410.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
EPO
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
HMO
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
Medicaid
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
Medicare Part A
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
Medicare Part B
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
POS
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
PPO
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
blue cross blue shield - medicare advantage
Workers Comp
O
27939.90
4320.81
7794.60
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
EPO
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
HMO
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
Medicaid
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
Medicare Part A
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
Medicare Part B
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
POS
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
PPO
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36830
null
cpt
Connection of tube graft to vein and artery for dialysis
humana - medicare advantage
Workers Comp
O
27939.90
4320.81
4320.81
7794.60
16763.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
EPO
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
HMO
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
Medicaid
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
Medicare Part A
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
Medicare Part B
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
POS
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
PPO
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
tricare
Workers Comp
I
20146.01
6401.98
6401.98
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
EPO
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
HMO
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
Medicaid
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
Medicare Part A
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
Medicare Part B
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
POS
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
PPO
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
369
null
ms-drg
major esophageal disorders with cc
va
Workers Comp
I
20146.01
6401.98
7138.21
7138.21
12087.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
EPO
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
HMO
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicaid
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part A
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part B
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
POS
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
PPO
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Workers Comp
O
8165.53
1245.33
4424.52
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
EPO
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
HMO
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
POS
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
PPO
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
8165.53
1245.33
1245.33
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
EPO
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
HMO
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
Medicaid
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
Medicare Part A
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
Medicare Part B
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
POS
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
PPO
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36901
null
cpt
Insertion of needle and/or catheter into dialysis circuit with imaging including radiological supervision and interpretation
united healthcare
Workers Comp
O
8165.53
1245.33
10996.19
10996.19
4899.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
EPO
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
HMO
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
Medicaid
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
Medicare Part A
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
Medicare Part B
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
POS
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
PPO
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield
Workers Comp
O
15765.70
4389.28
13163.81
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
EPO
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
HMO
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicaid
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part A
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Medicare Part B
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
POS
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
PPO
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
blue cross blue shield - medicare advantage
Workers Comp
O
15765.70
4389.28
13326.96
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
EPO
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
HMO
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
POS
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
PPO
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36902
null
cpt
Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
15765.70
4389.28
4389.28
13326.96
9459.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
EPO
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
HMO
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
POS
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
PPO
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36903
null
cpt
Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment with imaging including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
37590.58
8894.43
8894.43
8894.43
22554.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
EPO
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
HMO
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
Medicaid
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
Medicare Part A
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
Medicare Part B
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
POS
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
PPO
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36905
null
cpt
Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment  accessed through the skin with imaging including radiological supervision an
humana - medicare advantage
Workers Comp
O
30211.93
8004.99
8004.99
8004.99
18127.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
EPO
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
HMO
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
Medicaid
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
Medicare Part A
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
Medicare Part B
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
POS
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
PPO
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36906
null
cpt
Removal or dissolving of blood clot in dialysis circuit with balloon dilation of dialysis segment and placement of stent accessed through skin with imaging
humana - medicare advantage
Workers Comp
O
49974.86
14226.92
14226.92
14226.92
29984.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
EPO
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
HMO
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicaid
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part A
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
Medicare Part B
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
POS
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
PPO
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
humana - medicare advantage
Workers Comp
O
21848.10
2917.49
2917.49
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
EPO
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
HMO
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
Medicaid
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
Medicare Part A
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
Medicare Part B
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
POS
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
PPO
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
36907
null
cpt
Balloon dilation of dialysis segment accessed through the skin with imaging including radiological supervision and interpretation
united healthcare
Workers Comp
O
21848.10
2917.49
10996.19
10996.19
13108.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
EPO
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
HMO
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
Medicaid
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
Medicare Part A
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
Medicare Part B
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
POS
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
PPO
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
humana - medicare advantage
Workers Comp
I
49047.69
9933.42
9933.42
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
EPO
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
HMO
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
Medicaid
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
Medicare Part A
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
Medicare Part B
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
POS
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
PPO
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
371
null
ms-drg
major gastrointestinal disorders and peritoneal infections with mcc
va
Workers Comp
I
49047.69
9933.42
11142.92
11142.92
29428.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
EPO
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
HMO
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
Medicaid
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
Medicare Part A
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
Medicare Part B
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
POS
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
PPO
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37184
null
cpt
Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance accessed through the skin initial vessel
united healthcare - medicare advantage
Workers Comp
O
135810.99
22254.54
22254.54
22254.54
81486.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
EPO
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
HMO
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
Medicaid
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
Medicare Part A
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
Medicare Part B
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
POS
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
PPO
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
blue cross blue shield
Workers Comp
I
25805.14
5236.27
11913.75
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
EPO
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
HMO
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
Medicaid
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
Medicare Part A
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
Medicare Part B
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
POS
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
PPO
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
humana - medicare advantage
Workers Comp
I
25805.14
5236.27
5582.30
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
EPO
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
HMO
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
Medicaid
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
Medicare Part A
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
Medicare Part B
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
POS
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
PPO
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
372
null
ms-drg
major gastrointestinal disorders and peritoneal infections with cc
tricare
Workers Comp
I
25805.14
5236.27
5236.27
11913.75
15483.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
EPO
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
HMO
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
Medicaid
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
Medicare Part A
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
Medicare Part B
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
POS
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
PPO
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37215
null
cpt
Insertion of stents and blood clot protection device in neck artery open or accessed through the skin
va
Workers Comp
O
41024.05
16.23
16.23
16.23
24614.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
EPO
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
HMO
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
Medicaid
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
Medicare Part A
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
Medicare Part B
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
POS
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
PPO
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
blue cross blue shield
Workers Comp
O
46086.79
8539.57
8539.57
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37220
null
cpt
Balloon dilation of artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
46086.79
8539.57
8646.05
8646.05
27652.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
63849.22
11415.45
11415.45
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
EPO
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
HMO
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
Medicaid
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
Medicare Part A
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
Medicare Part B
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
POS
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
PPO
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37221
null
cpt
Insertion of stents in artery in one side of groin endovascular accessed through the skin or open procedure
va
Workers Comp
O
63849.22
11415.45
14226.44
14226.44
38309.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
EPO
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
HMO
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
Medicaid
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
Medicare Part A
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
Medicare Part B
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
POS
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
PPO
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
aetna - medicare advantage
Workers Comp
O
38403.63
4307.30
4307.30
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
EPO
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
HMO
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
Medicaid
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
Medicare Part A
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
Medicare Part B
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
POS
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
PPO
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
blue cross blue shield
Workers Comp
O
38403.63
4307.30
13560.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
38403.63
4307.30
4388.57
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
EPO
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
HMO
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicaid
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicare Part A
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicare Part B
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
POS
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
PPO
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
tricare
Workers Comp
O
38403.63
4307.30
4389.98
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
EPO
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
HMO
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
Medicaid
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part A
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part B
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
POS
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
PPO
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37224
null
cpt
Balloon dilation of arteries in one leg endovascular accessed through the skin or open procedure
va
Workers Comp
O
38403.63
4307.30
4389.83
13560.57
23042.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37225
null
cpt
Removal of plaque in arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
81321.21
8894.43
8894.43
8894.43
48792.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
73217.31
8777.72
13894.97
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
EPO
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
HMO
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicaid
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicare Part A
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
Medicare Part B
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
POS
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
PPO
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
tricare
Workers Comp
O
73217.31
8777.72
8777.72
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
EPO
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
HMO
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicaid
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part A
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part B
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
POS
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
PPO
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37226
null
cpt
Insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Workers Comp
O
73217.31
8777.72
13864.52
13894.97
43930.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
EPO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
HMO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
Medicaid
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
Medicare Part A
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
Medicare Part B
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
POS
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
PPO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
aetna
Workers Comp
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
100166.47
14120.90
14120.90
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
EPO
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
HMO
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicaid
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part A
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part B
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
POS
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
PPO
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Workers Comp
O
100166.47
14120.90
22254.54
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
EPO
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
HMO
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicaid
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part A
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Medicare Part B
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
POS
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
PPO
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37227
null
cpt
Removal of plaque and insertion of stents into arteries in one leg endovascular accessed through the skin or open procedure
va
Workers Comp
O
100166.47
14120.90
14226.44
22254.54
60099.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
EPO
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
HMO
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
Medicaid
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
POS
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
PPO
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
blue cross blue shield - medicare advantage
Workers Comp
O
71198.30
8646.05
13171.96
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
71198.30
8646.05
8646.05
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
EPO
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
HMO
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicaid
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part A
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part B
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
POS
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
PPO
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Workers Comp
O
71198.30
8646.05
22254.54
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
EPO
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
HMO
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
Medicaid
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
Medicare Part A
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
Medicare Part B
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
POS
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
PPO
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37228
null
cpt
Balloon dilation of artery of one leg endovascular accessed through the skin or open procedure
va
Workers Comp
O
71198.30
8646.05
13864.52
22254.54
42718.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
EPO
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
HMO
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicaid
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part A
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Medicare Part B
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
POS
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
PPO
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37229
null
cpt
Removal of plaque in artery in one leg endovascular accessed through the skin or open procedure
united healthcare - medicare advantage
Workers Comp
O
93428.27
14120.90
14120.90
14120.90
56056.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37230
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
91614.11
14120.90
14120.90
14120.90
54968.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37231
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
118484.93
12751.22
12751.22
12751.22
71090.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
EPO
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
HMO
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicaid
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part A
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Medicare Part B
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
POS
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
PPO
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37232
null
cpt
Balloon dilation of artery in one leg endovascular accessed through the skin or open procedure
humana - medicare advantage
Workers Comp
O
85410.08
11383.48
11383.48
11383.48
51246.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
EPO
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
HMO
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicaid
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicare Part A
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicare Part B
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
POS
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
PPO
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37234
null
cpt
Insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Workers Comp
O
91967.86
14226.92
14226.92
14226.92
55180.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
EPO
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
HMO
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicaid
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicare Part A
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Medicare Part B
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
POS
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
PPO
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37235
null
cpt
Removal of plaque and insertion of stents into artery in one leg endovascular accessed through the skin or open procedure each additional vessel
humana - medicare advantage
Workers Comp
O
106725.22
11381.54
11381.54
11381.54
64035.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
EPO
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
HMO
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
Medicaid
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
Medicare Part A
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
Medicare Part B
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
POS
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
PPO
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37236
null
cpt
Insertion of intravascular stents in artery (except lower extremity cervical carotid extracranial vertebral or intrathoracic carotid intracranial or coronary) open or accessed through the skin with ra
humana - medicare advantage
Workers Comp
O
60480.46
8777.72
8777.72
8777.72
36288.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
EPO
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
HMO
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
Medicaid
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
Medicare Part A
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
Medicare Part B
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
POS
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
PPO
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37246
null
cpt
Balloon dilation of artery accessed through the skin or by open procedure with imaging including radiological supervision and interpretation initial artery
humana - medicare advantage
Workers Comp
O
27943.86
4388.57
4388.57
4388.57
16766.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
EPO
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
HMO
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicaid
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicare Part A
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicare Part B
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
POS
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
PPO
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37252
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Workers Comp
O
86701.45
14120.90
14120.90
14120.90
52020.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
EPO
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
HMO
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
Medicaid
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
Medicare Part A
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
Medicare Part B
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
POS
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
PPO
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37253
null
cpt
Ultrasound evaluation of blood vessel during diagnosis or treatment each additional vessel
humana - medicare advantage
Workers Comp
O
99518.32
14120.90
14120.90
14120.90
59710.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
EPO
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
HMO
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
Medicaid
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
Medicare Part A
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
Medicare Part B
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
POS
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
PPO
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
blue cross blue shield
Workers Comp
I
29406.54
5268.18
8574.75
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
EPO
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
HMO
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
Medicaid
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
Medicare Part A
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
Medicare Part B
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
POS
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
PPO
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
373
null
ms-drg
major gastrointestinal disorders and peritoneal infections without cc/mcc
va
Workers Comp
I
29406.54
5268.18
5268.18
8574.75
17643.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
EPO
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
HMO
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
Medicaid
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
Medicare Part A
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
Medicare Part B
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
POS
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
PPO
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
374
null
ms-drg
digestive malignancy with mcc
humana - medicare advantage
Workers Comp
I
33325.82
11567.59
11567.59
11567.59
19995.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
EPO
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
HMO
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
Medicaid
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
POS
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
PPO
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
375
null
ms-drg
digestive malignancy with cc
blue cross blue shield - medicare advantage
Workers Comp
I
27920.16
10287.24
10287.24
10287.24
16752.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
EPO
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
HMO
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
Medicaid
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
Medicare Part A
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
Medicare Part B
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
POS
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
PPO
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37609
null
cpt
Tying or biopsy of temporal artery (side of skull)
humana - medicare advantage
Workers Comp
O
15714.07
1246.10
1246.10
1246.10
9428.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
EPO
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
HMO
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
Medicaid
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
Medicare Part A
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
Medicare Part B
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
POS
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
PPO
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
377
null
ms-drg
gastrointestinal hemorrhage with mcc
tricare
Workers Comp
I
41018.23
11346.04
11346.04
11346.04
24610.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
EPO
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
HMO
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
Medicaid
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
Medicare Part A
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
Medicare Part B
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
POS
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
PPO
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
cigna
Workers Comp
O
20637.18
2241.27
16128.00
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
EPO
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
HMO
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
Medicaid
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
Medicare Part A
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
Medicare Part B
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
POS
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
PPO
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
humana - medicare advantage
Workers Comp
O
20637.18
2241.27
2241.27
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
EPO
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
HMO
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
Medicaid
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
Medicare Part A
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
Medicare Part B
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
POS
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
PPO
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
tricare
Workers Comp
O
20637.18
2241.27
2534.40
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
EPO
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
HMO
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
Medicaid
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
Medicare Part A
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
Medicare Part B
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
POS
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
PPO
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37765
null
cpt
Multiple incisions for removal of varicose veins of arm or leg 10-20 incisions
united healthcare
Workers Comp
O
20637.18
2241.27
12140.26
16128.00
12382.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
EPO
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
HMO
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
Medicaid
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
Medicare Part A
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
Medicare Part B
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
POS
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
PPO
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
aetna - medicare advantage
Workers Comp
O
21582.53
200.71
2534.40
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
EPO
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
HMO
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
Medicaid
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
Medicare Part A
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
Medicare Part B
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
POS
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
PPO
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield
Workers Comp
O
21582.53
200.71
12086.89
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
EPO
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
HMO
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
Medicaid
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
Medicare Part A
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
Medicare Part B
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
POS
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
PPO
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
blue cross blue shield - medicare advantage
Workers Comp
O
21582.53
200.71
200.71
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
EPO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
HMO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
Medicaid
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
Medicare Part A
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
Medicare Part B
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
POS
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
PPO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
humana - medicare advantage
Workers Comp
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
EPO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
HMO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
Medicaid
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
Medicare Part A
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
Medicare Part B
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
POS
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
PPO
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
tricare
Workers Comp
O
21582.53
200.71
2455.02
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
EPO
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
HMO
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
Medicaid
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
Medicare Part A
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
Medicare Part B
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
POS
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
PPO
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37766
null
cpt
Multiple incisions for removal of varicose veins of arm or leg greater than 20 incisions
va
Workers Comp
O
21582.53
200.71
2534.31
12086.89
12949.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
EPO
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
HMO
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
Medicaid
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
Medicare Part A
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
Medicare Part B
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
POS
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
PPO
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
blue cross blue shield
Workers Comp
O
22081.32
2534.40
12086.89
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
EPO
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
HMO
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
Medicaid
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
Medicare Part A
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
Medicare Part B
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
POS
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
PPO
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
37799
null
cpt
Blood vessel procedure
tricare
Workers Comp
O
22081.32
2534.40
2534.40
12086.89
13248.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
EPO
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
HMO
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
Medicaid
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
Medicare Part A
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
Medicare Part B
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
POS
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
PPO
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield
Workers Comp
I
21457.59
3674.69
10915.88
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
EPO
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
HMO
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
Medicaid
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
POS
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
PPO
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
blue cross blue shield - medicare advantage
Workers Comp
I
21457.59
3674.69
8624.03
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
EPO
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
HMO
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
Medicaid
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
Medicare Part A
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
Medicare Part B
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
POS
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
PPO
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
humana - medicare advantage
Workers Comp
I
21457.59
3674.69
6332.68
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
EPO
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
HMO
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
Medicaid
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
Medicare Part A
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
Medicare Part B
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
POS
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
PPO
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
tricare
Workers Comp
I
21457.59
3674.69
3674.69
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
EPO
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
HMO
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
Medicaid
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
Medicare Part A
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
Medicare Part B
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
POS
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
PPO
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
united healthcare
Workers Comp
I
21457.59
3674.69
6117.97
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
EPO
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
HMO
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
Medicaid
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
Medicare Part A
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
Medicare Part B
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
POS
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
PPO
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
378
null
ms-drg
gastrointestinal hemorrhage with cc
va
Workers Comp
I
21457.59
3674.69
6580.94
10915.88
12874.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
EPO
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
HMO
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
Medicaid
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
Medicare Part A
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
Medicare Part B
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
POS
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
PPO
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
humana - medicare advantage
Workers Comp
I
35516.50
11035.58
11384.92
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
EPO
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
HMO
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
Medicaid
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
Medicare Part A
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
Medicare Part B
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
POS
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
PPO
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
380
null
ms-drg
complicated peptic ulcer with mcc
united healthcare - medicare advantage
Workers Comp
I
35516.50
11035.58
11035.58
11384.92
21309.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
EPO
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
HMO
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
Medicaid
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
Medicare Part A
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
Medicare Part B
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
POS
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
PPO
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
blue cross blue shield
Workers Comp
I
22768.40
5889.73
10309.87
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
EPO
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
HMO
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
Medicaid
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
Medicare Part A
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
Medicare Part B
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
POS
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
PPO
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
381
null
ms-drg
complicated peptic ulcer with cc
humana - medicare advantage
Workers Comp
I
22768.40
5889.73
5889.73
10309.87
13661.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
EPO
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
HMO
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
Medicaid
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
Medicare Part A
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
Medicare Part B
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
POS
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
PPO
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38220
null
cpt
Aspiration of bone marrow
tricare
Workers Comp
O
22353.72
5548.49
5548.49
5548.49
13412.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
EPO
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
HMO
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
Medicaid
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
Medicare Part A
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
Medicare Part B
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
POS
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
PPO
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
blue cross blue shield - medicare advantage
Workers Comp
O
10459.53
1143.84
1143.84
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
EPO
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
HMO
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
Medicaid
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
Medicare Part A
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
Medicare Part B
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
POS
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
PPO
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38221
null
cpt
Biopsy of bone marrow
united healthcare - medicare advantage
Workers Comp
O
10459.53
1143.84
1162.46
1162.46
6275.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
EPO
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
HMO
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
Medicaid
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
Medicare Part A
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
Medicare Part B
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
POS
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
PPO
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
blue cross blue shield
Workers Comp
O
6328.00
1567.18
1567.18
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
EPO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
HMO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
Medicaid
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
Medicare Part A
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
Medicare Part B
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
POS
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
PPO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
humana - medicare advantage
Workers Comp
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
EPO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
HMO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
Medicaid
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
Medicare Part A
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
Medicare Part B
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
POS
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
PPO
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
tricare
Workers Comp
O
6328.00
1567.18
2098.98
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
EPO
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
HMO
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
Medicaid
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
Medicare Part A
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
Medicare Part B
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
POS
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
PPO
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38222
null
cpt
Diagnostic aspirations and biopsies of bone marrow
va
Workers Comp
O
6328.00
1567.18
2098.90
2098.98
3796.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
EPO
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
HMO
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
Medicaid
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
Medicare Part A
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
Medicare Part B
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
POS
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
PPO
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
385
null
ms-drg
inflammatory bowel disease with mcc
tricare
Workers Comp
I
41241.30
9731.58
9731.58
9731.58
24744.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
EPO
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
HMO
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
Medicaid
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
Medicare Part A
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
Medicare Part B
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
POS
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
PPO
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
blue cross blue shield
Workers Comp
O
25073.31
3718.12
17090.22
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
EPO
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
HMO
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
Medicaid
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
Medicare Part A
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
Medicare Part B
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
POS
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
PPO
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
humana - medicare advantage
Workers Comp
O
25073.31
3718.12
4596.82
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
EPO
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
HMO
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
Medicaid
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
Medicare Part A
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
Medicare Part B
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
POS
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
PPO
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38500
null
cpt
Biopsy or removal of lymph nodes open procedure
tricare
Workers Comp
O
25073.31
3718.12
3718.12
17090.22
15043.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
EPO
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
HMO
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
Medicaid
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
Medicare Part A
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
Medicare Part B
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
POS
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
PPO
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
aetna
Workers Comp
O
5965.16
1246.10
5519.40
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
EPO
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
HMO
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
Medicaid
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
Medicare Part A
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
Medicare Part B
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
POS
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
PPO
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
blue cross blue shield
Workers Comp
O
5965.16
1246.10
2544.47
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
EPO
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
HMO
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
Medicaid
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
Medicare Part A
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
Medicare Part B
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
POS
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
PPO
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38505
null
cpt
Needle biopsy or removal of lymph nodes
humana - medicare advantage
Workers Comp
O
5965.16
1246.10
1246.10
5519.40
3579.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
EPO
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
HMO
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
Medicaid
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
Medicare Part A
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
Medicare Part B
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
POS
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
PPO
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
blue cross blue shield
Workers Comp
O
24157.39
2683.82
7997.59
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
EPO
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
HMO
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
Medicaid
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
Medicare Part A
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
Medicare Part B
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
POS
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
PPO
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38510
null
cpt
Biopsy or removal of lymph nodes of neck open procedure
humana - medicare advantage
Workers Comp
O
24157.39
2683.82
2683.82
7997.59
14494.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
EPO
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
HMO
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
Medicaid
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
Medicare Part A
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
Medicare Part B
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
POS
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
PPO
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
blue cross blue shield
Workers Comp
O
28110.72
3661.72
12540.05
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
EPO
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
HMO
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
Medicaid
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
Medicare Part A
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
Medicare Part B
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
POS
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
PPO
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
humana - medicare advantage
Workers Comp
O
28110.72
3661.72
4901.08
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
EPO
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
HMO
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
Medicaid
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
Medicare Part A
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
Medicare Part B
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
POS
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
PPO
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
tricare
Workers Comp
O
28110.72
3661.72
3661.72
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
EPO
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
HMO
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
Medicaid
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
Medicare Part A
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
Medicare Part B
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
POS
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
PPO
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38525
null
cpt
Biopsy or removal of lymph nodes of under the arm open procedure
worker comp
Workers Comp
O
28110.72
3661.72
15523.00
15523.00
16866.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
EPO
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
HMO
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
Medicaid
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
Medicare Part A
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
Medicare Part B
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
POS
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
PPO
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
blue cross blue shield
Workers Comp
O
17707.56
2683.82
5253.08
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
EPO
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
HMO
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
Medicaid
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
Medicare Part A
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
Medicare Part B
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
POS
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
PPO
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
humana - medicare advantage
Workers Comp
O
17707.56
2683.82
2740.22
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
EPO
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
HMO
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
Medicaid
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
Medicare Part A
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
Medicare Part B
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
POS
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
PPO
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38531
null
cpt
Open biopsy or excision of lymph nodes in groin
tricare
Workers Comp
O
17707.56
2683.82
2683.82
5253.08
10624.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
EPO
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
HMO
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
Medicaid
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
Medicare Part A
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
Medicare Part B
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
POS
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
PPO
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
386
null
ms-drg
inflammatory bowel disease with cc
tricare
Workers Comp
I
19594.19
6135.69
6135.69
6135.69
11756.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
EPO
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
HMO
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
Medicaid
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
Medicare Part A
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
Medicare Part B
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
POS
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
PPO
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
blue cross blue shield
Workers Comp
O
29331.60
2482.87
11700.59
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
EPO
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
HMO
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
Medicaid
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
Medicare Part A
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
Medicare Part B
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
POS
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
PPO
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
humana - medicare advantage
Workers Comp
O
29331.60
2482.87
4901.08
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
EPO
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
HMO
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
Medicaid
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
Medicare Part A
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
Medicare Part B
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
POS
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
PPO
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38792
null
cpt
Injection of radioactive dye for X-ray identification of lymph node
tricare
Workers Comp
O
29331.60
2482.87
2482.87
11700.59
17598.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
EPO
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
HMO
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
Medicaid
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
Medicare Part A
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
Medicare Part B
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
POS
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
PPO
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
blue cross blue shield
Workers Comp
I
30623.63
9338.95
14418.67
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
EPO
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
HMO
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
Medicaid
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
Medicare Part A
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
Medicare Part B
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
POS
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
PPO
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
humana - medicare advantage
Workers Comp
I
30623.63
9338.95
9949.31
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
EPO
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
HMO
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
Medicaid
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
Medicare Part A
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
Medicare Part B
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
POS
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
PPO
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
388
null
ms-drg
gastrointestinal obstruction with mcc
va
Workers Comp
I
30623.63
9338.95
9338.95
14418.67
18374.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
EPO
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
HMO
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
Medicaid
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
Medicare Part A
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
Medicare Part B
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
POS
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
PPO
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield
Workers Comp
I
19325.62
5496.16
8867.53
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
EPO
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
HMO
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
Medicaid
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
POS
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
PPO
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
blue cross blue shield - medicare advantage
Workers Comp
I
19325.62
5496.16
6339.29
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
EPO
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
HMO
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
Medicaid
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
Medicare Part A
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
Medicare Part B
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
POS
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
PPO
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
humana - medicare advantage
Workers Comp
I
19325.62
5496.16
5496.16
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
EPO
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
HMO
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
Medicaid
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
Medicare Part A
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
Medicare Part B
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
POS
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
PPO
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
united healthcare
Workers Comp
I
19325.62
5496.16
16489.31
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
EPO
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
HMO
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
Medicaid
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
Medicare Part A
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
Medicare Part B
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
POS
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
PPO
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
va
Workers Comp
I
19325.62
5496.16
5618.30
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
EPO
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
HMO
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
Medicaid
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
Medicare Part A
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
Medicare Part B
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
POS
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
PPO
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
389
null
ms-drg
gastrointestinal obstruction with cc
webtpa
Workers Comp
I
19325.62
5496.16
5825.61
16489.31
11595.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
EPO
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
HMO
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
Medicaid
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
Medicare Part A
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
Medicare Part B
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
POS
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
PPO
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
blue cross blue shield
Workers Comp
O
26132.47
4552.72
4628.06
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
EPO
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
HMO
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
Medicaid
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
Medicare Part A
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
Medicare Part B
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
POS
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
PPO
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
38900
null
cpt
Lymph node imaging during surgery
humana - medicare advantage
Workers Comp
O
26132.47
4552.72
4552.72
4628.06
15679.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
EPO
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
HMO
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
Medicaid
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
Medicare Part A
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
Medicare Part B
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
POS
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
PPO
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
blue cross blue shield
Workers Comp
I
13292.38
2947.02
6711.75
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
EPO
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
HMO
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
Medicaid
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
Medicare Part A
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
Medicare Part B
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
POS
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
PPO
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
humana - medicare advantage
Workers Comp
I
13292.38
2947.02
3873.80
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
EPO
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
HMO
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
Medicaid
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
Medicare Part A
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
Medicare Part B
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
POS
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
PPO
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
390
null
ms-drg
gastrointestinal obstruction without cc/mcc
tricare
Workers Comp
I
13292.38
2947.02
2947.02
6711.75
7975.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
EPO
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
HMO
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
Medicaid
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
POS
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
PPO
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
31328.09
7006.45
9247.52
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
EPO
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
HMO
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
Medicaid
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
Medicare Part A
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
Medicare Part B
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
POS
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
PPO
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
humana - medicare advantage
Workers Comp
I
31328.09
7006.45
7073.49
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
EPO
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
HMO
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
Medicaid
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
Medicare Part A
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
Medicare Part B
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
POS
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
PPO
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
391
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders with mcc
tricare
Workers Comp
I
31328.09
7006.45
7006.45
9247.52
18796.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
EPO
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
HMO
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
Medicaid
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
Medicare Part A
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
Medicare Part B
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
POS
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
PPO
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
aetna
Workers Comp
I
18228.25
4089.27
8777.64
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
EPO
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
HMO
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
Medicaid
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
Medicare Part A
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
Medicare Part B
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
POS
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
PPO
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield
Workers Comp
I
18228.25
4089.27
6645.38
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
EPO
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
HMO
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
Medicaid
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
POS
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
PPO
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
18228.25
4089.27
6236.13
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
EPO
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
HMO
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
Medicaid
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
Medicare Part A
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
Medicare Part B
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
POS
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
PPO
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
cigna
Workers Comp
I
18228.25
4089.27
6929.49
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
EPO
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
HMO
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
Medicaid
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
Medicare Part A
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
Medicare Part B
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
POS
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
PPO
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
humana - medicare advantage
Workers Comp
I
18228.25
4089.27
4482.39
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
EPO
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
HMO
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
Medicaid
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
Medicare Part A
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
Medicare Part B
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
POS
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
PPO
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
tricare
Workers Comp
I
18228.25
4089.27
4089.27
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
EPO
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
HMO
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
Medicaid
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
Medicare Part A
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
Medicare Part B
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
POS
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
PPO
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
va
Workers Comp
I
18228.25
4089.27
5213.57
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
EPO
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
HMO
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
Medicaid
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
Medicare Part A
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
Medicare Part B
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
POS
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
PPO
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
392
null
ms-drg
esophagitis gastroenteritis and miscellaneous digestive disorders without mcc
webtpa
Workers Comp
I
18228.25
4089.27
16954.67
16954.67
10936.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
EPO
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
HMO
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
Medicaid
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
Medicare Part A
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
Medicare Part B
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
POS
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
PPO
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
humana - medicare advantage
Workers Comp
I
29060.49
9042.39
9042.39
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
EPO
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
HMO
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
Medicaid
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
Medicare Part A
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
Medicare Part B
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
POS
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
PPO
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
393
null
ms-drg
other digestive system diagnoses with mcc
va
Workers Comp
I
29060.49
9042.39
10937.88
10937.88
17436.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
EPO
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
HMO
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
Medicaid
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
Medicare Part A
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
Medicare Part B
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
POS
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
PPO
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
aetna - medicare advantage
Workers Comp
I
25914.17
4763.03
6573.83
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
EPO
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
HMO
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
Medicaid
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
Medicare Part A
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
Medicare Part B
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
POS
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
PPO
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
blue cross blue shield
Workers Comp
I
25914.17
4763.03
10874.89
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
EPO
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
HMO
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
Medicaid
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
Medicare Part A
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
Medicare Part B
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
POS
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
PPO
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
394
null
ms-drg
other digestive system diagnoses with cc
humana - medicare advantage
Workers Comp
I
25914.17
4763.03
4763.03
10874.89
15548.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
EPO
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
HMO
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
Medicaid
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
Medicare Part A
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
Medicare Part B
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
POS
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
PPO
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
blue cross blue shield
Workers Comp
O
24597.93
4282.09
25265.30
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
EPO
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
HMO
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
Medicaid
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
Medicare Part A
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
Medicare Part B
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
POS
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
PPO
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39401
null
cpt
Examination of chest using an endoscope with biopsy
humana - medicare advantage
Workers Comp
O
24597.93
4282.09
4282.09
25265.30
14758.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
EPO
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
HMO
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
Medicaid
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
Medicare Part A
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
Medicare Part B
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
POS
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
PPO
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
39402
null
cpt
Examination of chest using an endoscope with lymph node biopsy
humana - medicare advantage
Workers Comp
O
19611.87
4282.09
4282.09
4282.09
11767.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
EPO
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
HMO
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
Medicaid
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
Medicare Part A
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
Medicare Part B
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
POS
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
PPO
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
395
null
ms-drg
other digestive system diagnoses without cc/mcc
tricare
Workers Comp
I
14282.93
4324.06
4324.06
4324.06
8569.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
EPO
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
HMO
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
Medicaid
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
Medicare Part A
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
Medicare Part B
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
POS
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
PPO
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40490
null
cpt
Biopsy of lip
humana - medicare advantage
Workers Comp
O
1175.48
623.16
623.16
623.16
705.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
EPO
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
HMO
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
Medicaid
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
Medicare Part A
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
Medicare Part B
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
POS
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
PPO
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
40808
null
cpt
Biopsy of mouth
blue cross blue shield - medicare advantage
Workers Comp
O
20371.53
6065.40
6065.40
6065.40
12222.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
EPO
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
HMO
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
Medicaid
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
Medicare Part A
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
Medicare Part B
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
POS
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
PPO
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41105
null
cpt
Biopsy of tongue back on third
blue cross blue shield - medicare advantage
Workers Comp
O
19947.90
8797.66
8797.66
8797.66
11968.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
EPO
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
HMO
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
Medicaid
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
POS
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
PPO
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
414
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
55683.14
29129.87
29129.87
29129.87
33409.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
EPO
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
HMO
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
Medicaid
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
Medicare Part A
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
Medicare Part B
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
POS
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
PPO
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
blue cross blue shield
Workers Comp
I
58542.15
12174.53
19326.82
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
EPO
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
HMO
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
Medicaid
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
Medicare Part A
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
Medicare Part B
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
POS
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
PPO
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
415
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. with cc
humana - medicare advantage
Workers Comp
I
58542.15
12174.53
12174.53
19326.82
35125.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
POS
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
416
null
ms-drg
cholecystectomy except by laparoscope without c.d.e. without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
33072.25
11517.09
11517.09
11517.09
19843.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
EPO
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
HMO
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
Medicaid
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
Medicare Part A
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
Medicare Part B
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
POS
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
PPO
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
417
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with mcc
tricare
Workers Comp
I
31514.98
7252.72
7252.72
7252.72
18908.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
EPO
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
HMO
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
Medicaid
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
Medicare Part A
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
Medicare Part B
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
POS
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
PPO
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield
Workers Comp
I
43465.52
10261.12
16348.93
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
EPO
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
HMO
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
Medicaid
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
POS
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
PPO
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
blue cross blue shield - medicare advantage
Workers Comp
I
43465.52
10261.12
14265.00
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
EPO
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
HMO
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
Medicaid
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
Medicare Part A
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
Medicare Part B
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
POS
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
PPO
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
tricare
Workers Comp
I
43465.52
10261.12
10261.12
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
EPO
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
HMO
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
Medicaid
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
Medicare Part A
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
Medicare Part B
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
POS
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
PPO
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
418
null
ms-drg
laparoscopic cholecystectomy without c.d.e. with cc
united healthcare - medicare advantage
Workers Comp
I
43465.52
10261.12
10767.42
16348.93
26079.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
EPO
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
HMO
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
Medicaid
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
Medicare Part A
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
Medicare Part B
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
POS
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
PPO
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
41899
null
cpt
Relocation of mouth tissue to gum surface
tricare
Workers Comp
O
13391.21
180.40
180.40
180.40
8034.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
EPO
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
HMO
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
Medicaid
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
Medicare Part A
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
Medicare Part B
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
POS
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
PPO
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
blue cross blue shield
Workers Comp
I
42090.08
8460.55
15050.26
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
EPO
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
HMO
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
Medicaid
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
Medicare Part A
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
Medicare Part B
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
POS
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
PPO
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
419
null
ms-drg
laparoscopic cholecystectomy without c.d.e. without cc/mcc
tricare
Workers Comp
I
42090.08
8460.55
8460.55
15050.26
25254.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
EPO
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
HMO
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
Medicaid
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
Medicare Part A
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
Medicare Part B
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
POS
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
PPO
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
421
null
ms-drg
hepatobiliary diagnostic procedures with cc
tricare
Workers Comp
I
63808.34
10476.93
10476.93
10476.93
38285.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
EPO
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
HMO
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
Medicaid
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
Medicare Part A
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
Medicare Part B
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
POS
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
PPO
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42106
null
cpt
Removal of growth of roof of mouth with simple suturing
blue cross blue shield - medicare advantage
Workers Comp
O
15688.11
3333.14
3333.14
3333.14
9412.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
EPO
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
HMO
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
Medicaid
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
Medicare Part A
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
Medicare Part B
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
POS
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
PPO
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42140
null
cpt
Removal of soft tissue at roof of mouth simple
blue cross blue shield - medicare advantage
Workers Comp
O
16599.94
3378.80
3378.80
3378.80
9959.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
EPO
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
HMO
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
Medicaid
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
Medicare Part A
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
Medicare Part B
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
POS
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
PPO
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42415
null
cpt
Partial removal of salivary gland growth with release of facial nerve
blue cross blue shield
Workers Comp
O
27751.48
10684.99
10684.99
10684.99
16650.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
EPO
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
HMO
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
Medicaid
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
Medicare Part A
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
Medicare Part B
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
POS
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
PPO
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
tricare
Workers Comp
O
16855.99
2423.46
2423.46
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
EPO
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
HMO
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
Medicaid
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
Medicare Part A
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
Medicare Part B
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
POS
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
PPO
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
42826
null
cpt
Removal of tonsils patient age 12 or over
va
Workers Comp
O
16855.99
2423.46
7492.06
7492.06
10113.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
EPO
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
HMO
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
Medicaid
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
Medicare Part A
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
Medicare Part B
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
POS
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
PPO
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna
Workers Comp
O
3059.46
696.23
1399.33
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
EPO
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
HMO
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
Medicaid
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
Medicare Part A
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
Medicare Part B
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
POS
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
PPO
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
aetna - medicare advantage
Workers Comp
O
3059.46
696.23
696.23
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
EPO
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
HMO
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
Medicaid
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
Medicare Part A
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
Medicare Part B
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
POS
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
PPO
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield
Workers Comp
O
3059.46
696.23
1324.78
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
EPO
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
HMO
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
Medicaid
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
Medicare Part A
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
Medicare Part B
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
POS
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
PPO
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
blue cross blue shield - medicare advantage
Workers Comp
O
3059.46
696.23
1379.51
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
EPO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
HMO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
Medicaid
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
Medicare Part A
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
Medicare Part B
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
POS
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
PPO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
humana - medicare advantage
Workers Comp
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
EPO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
HMO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
Medicaid
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
Medicare Part A
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
Medicare Part B
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
POS
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
PPO
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
tricare
Workers Comp
O
3059.46
696.23
717.01
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
EPO
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
HMO
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
Medicaid
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
Medicare Part A
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
Medicare Part B
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
POS
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
PPO
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43235
null
cpt
Endoscopy of throat stomach and intestines
va
Workers Comp
O
3059.46
696.23
1068.42
1399.33
860.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
EPO
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
HMO
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicaid
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part A
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part B
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
POS
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
PPO
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43236
null
cpt
Injections of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Workers Comp
O
4585.34
1895.79
1895.79
1895.79
2751.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
EPO
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
HMO
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
Medicaid
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
Medicare Part A
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
Medicare Part B
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
POS
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
PPO
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna
Workers Comp
O
4095.09
439.90
2282.87
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
EPO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
HMO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
Medicaid
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
Medicare Part A
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
Medicare Part B
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
POS
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
PPO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
aetna - medicare advantage
Workers Comp
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
EPO
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
HMO
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicaid
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part A
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part B
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
POS
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
PPO
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Workers Comp
O
4095.09
439.90
1708.10
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
EPO
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
HMO
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
POS
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
PPO
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
4095.09
439.90
1507.95
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
EPO
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
HMO
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
Medicaid
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
Medicare Part A
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
Medicare Part B
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
POS
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
PPO
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
cigna
Workers Comp
O
4095.09
439.90
3231.17
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
EPO
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
HMO
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
Medicaid
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
Medicare Part A
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
Medicare Part B
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
POS
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
PPO
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
healthchoice
Workers Comp
O
4095.09
439.90
439.90
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
EPO
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
HMO
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
Medicaid
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
Medicare Part A
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
Medicare Part B
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
POS
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
PPO
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
humana - medicare advantage
Workers Comp
O
4095.09
439.90
1034.59
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
EPO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
HMO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicaid
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicare Part A
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicare Part B
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
POS
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
PPO
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
tricare
Workers Comp
O
4095.09
439.90
717.01
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
EPO
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
HMO
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
Medicaid
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
Medicare Part A
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
Medicare Part B
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
POS
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
PPO
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare
Workers Comp
O
4095.09
439.90
2944.37
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
EPO
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
HMO
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
Medicaid
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
Medicare Part A
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
Medicare Part B
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
POS
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
PPO
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
united healthcare - medicare advantage
Workers Comp
O
4095.09
439.90
950.89
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
EPO
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
HMO
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
Medicaid
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
Medicare Part A
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
Medicare Part B
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
POS
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
PPO
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43239
null
cpt
Biopsy of the esophagus stomach and/or upper small bowel using an endoscope
va
Workers Comp
O
4095.09
439.90
1154.13
3231.17
1153.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
EPO
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
HMO
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
Medicaid
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
Medicare Part A
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
Medicare Part B
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
POS
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
PPO
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43243
null
cpt
Injection of dilated veins of stomach and/or esophagus using an endoscope
blue cross blue shield
Workers Comp
O
7145.25
1895.79
1895.79
1895.79
4287.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
EPO
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
HMO
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
Medicaid
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
Medicare Part A
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
Medicare Part B
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
POS
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
PPO
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43244
null
cpt
Tying of dilated veins of stomach and/or esophagus using an endoscope
cigna
Workers Comp
O
4036.48
2892.83
2892.83
2892.83
2421.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
EPO
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
HMO
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
Medicaid
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
Medicare Part A
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
Medicare Part B
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
POS
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
PPO
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43245
null
cpt
Dilation of stomach outlet using an endoscope
cigna
Workers Comp
O
5391.89
3539.01
3539.01
3539.01
3235.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
EPO
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
HMO
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
Medicaid
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
Medicare Part A
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
Medicare Part B
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
POS
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
PPO
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna
Workers Comp
O
3945.75
1365.87
9113.80
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
EPO
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
HMO
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
Medicaid
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
Medicare Part A
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
Medicare Part B
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
POS
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
PPO
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
aetna - medicare advantage
Workers Comp
O
3945.75
1365.87
1365.87
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
EPO
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
HMO
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
Medicaid
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
Medicare Part A
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
Medicare Part B
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
POS
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
PPO
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
tricare
Workers Comp
O
3945.75
1365.87
1439.18
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
EPO
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
HMO
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
Medicaid
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
Medicare Part A
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
Medicare Part B
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
POS
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
PPO
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
united healthcare
Workers Comp
O
3945.75
1365.87
2640.17
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
EPO
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
HMO
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
Medicaid
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
Medicare Part A
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
Medicare Part B
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
POS
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
PPO
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43246
null
cpt
Insertion of stomach tube using an endoscope
va
Workers Comp
O
3945.75
1365.87
1439.13
9113.80
2367.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
EPO
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
HMO
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicaid
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part A
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Medicare Part B
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
POS
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
PPO
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43247
null
cpt
Removal of foreign bodies of esophagus stomach and/or upper small bowel using an endoscope
blue cross blue shield
Workers Comp
O
3075.65
2195.33
2195.33
2195.33
1845.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
EPO
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
HMO
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
Medicaid
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
Medicare Part A
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
Medicare Part B
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
POS
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
PPO
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
aetna
Workers Comp
O
3433.93
966.99
2442.65
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
EPO
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
HMO
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
Medicaid
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
Medicare Part A
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
Medicare Part B
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
POS
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
PPO
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield
Workers Comp
O
3433.93
966.99
2198.10
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
EPO
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
HMO
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
POS
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
PPO
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
3433.93
966.99
2872.92
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
EPO
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
HMO
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
Medicaid
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
Medicare Part A
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
Medicare Part B
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
POS
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
PPO
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
humana - medicare advantage
Workers Comp
O
3433.93
966.99
966.99
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
EPO
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
HMO
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
Medicaid
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
Medicare Part A
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
Medicare Part B
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
POS
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
PPO
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
tricare
Workers Comp
O
3433.93
966.99
1044.35
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
EPO
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
HMO
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
Medicaid
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
Medicare Part A
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
Medicare Part B
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
POS
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
PPO
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43248
null
cpt
Insertion of guide wire with dilation of esophagus using an endoscope
va
Workers Comp
O
3433.93
966.99
1075.48
2872.92
2060.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
EPO
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
HMO
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
Medicaid
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
Medicare Part A
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
Medicare Part B
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
POS
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
PPO
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
aetna
Workers Comp
O
4909.14
1379.67
2668.43
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
EPO
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
HMO
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
Medicaid
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
Medicare Part A
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
Medicare Part B
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
POS
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
PPO
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield
Workers Comp
O
4909.14
1379.67
4091.72
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
EPO
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
HMO
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicaid
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
POS
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
PPO
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
4909.14
1379.67
4260.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
EPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
HMO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
Medicaid
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
Medicare Part A
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
Medicare Part B
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
POS
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
PPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
humana - medicare advantage
Workers Comp
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
EPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
HMO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
Medicaid
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
Medicare Part A
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
Medicare Part B
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
POS
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
PPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
tricare
Workers Comp
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
EPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
HMO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
Medicaid
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
Medicare Part A
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
Medicare Part B
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
POS
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
PPO
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
united healthcare - medicare advantage
Workers Comp
O
4909.14
1379.67
1379.67
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
EPO
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
HMO
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
Medicaid
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
Medicare Part A
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
Medicare Part B
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
POS
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
PPO
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43249
null
cpt
Balloon dilation of esophagus stomach and upper small bowel using a flexible endoscope
va
Workers Comp
O
4909.14
1379.67
1439.13
4260.13
2945.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
EPO
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
HMO
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
Medicaid
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
Medicare Part A
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
Medicare Part B
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
POS
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
PPO
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43255
null
cpt
Control of bleeding of esophagus stomach and/or upper small bowel using an endoscope
va
Workers Comp
O
4882.73
1402.52
1402.52
1402.52
2929.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
EPO
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
HMO
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
Medicaid
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
Medicare Part A
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
Medicare Part B
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
POS
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
PPO
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43262
null
cpt
Incision of pancreatic outlet using a flexible endoscope via mouth
humana - medicare advantage
Workers Comp
O
8857.54
2182.78
2182.78
2182.78
5314.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
EPO
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
HMO
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicaid
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicare Part A
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
Medicare Part B
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
POS
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
PPO
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43270
null
cpt
Destruction of growths on esophagus stomach and/or upper small bowel using an endoscope
tricare
Workers Comp
O
4610.77
1439.18
1439.18
1439.18
2766.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
EPO
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
HMO
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
Medicaid
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
Medicare Part A
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
Medicare Part B
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
POS
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
PPO
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43279
null
cpt
Repair of muscle to lower esophagus and stomach using an endoscope
united healthcare
Workers Comp
O
31025.28
23268.96
23268.96
23268.96
18615.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
EPO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
HMO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicaid
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicare Part A
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicare Part B
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
POS
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
PPO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Workers Comp
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
EPO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
HMO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
Medicaid
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
Medicare Part A
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
Medicare Part B
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
POS
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
PPO
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
tricare
Workers Comp
O
32333.60
7453.01
7453.01
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
EPO
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
HMO
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
Medicaid
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
Medicare Part A
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
Medicare Part B
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
POS
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
PPO
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43280
null
cpt
Repair of muscle at esophagus and stomach using an endoscope
united healthcare
Workers Comp
O
32333.60
7453.01
23111.69
23111.69
19400.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
EPO
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
HMO
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicaid
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicare Part A
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Medicare Part B
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
POS
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
PPO
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
humana - medicare advantage
Workers Comp
O
33508.00
7453.01
7936.97
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
EPO
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
HMO
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
Medicaid
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
Medicare Part A
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
Medicare Part B
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
POS
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
PPO
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43281
null
cpt
Repair of hernia of muscle at esophagus and stomach using an endoscope
tricare
Workers Comp
O
33508.00
7453.01
7453.01
7936.97
20104.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
EPO
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
HMO
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
Medicaid
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
Medicare Part A
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
Medicare Part B
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
POS
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
PPO
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43282
null
cpt
Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope
humana - medicare advantage
Workers Comp
O
35249.57
41520.44
41520.44
41520.44
21149.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
EPO
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
HMO
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
Medicaid
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
Medicare Part A
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
Medicare Part B
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
POS
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
PPO
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43284
null
cpt
Insertion of augmentation device in sphincter of esophagus using a flexible endoscope via mouth
humana - medicare advantage
Workers Comp
O
57285.78
7888.98
7888.98
7888.98
34371.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
EPO
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
HMO
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
Medicaid
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
Medicare Part A
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
Medicare Part B
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
POS
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
PPO
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
blue cross blue shield
Workers Comp
I
25141.69
5144.47
10629.20
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
EPO
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
HMO
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
Medicaid
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
Medicare Part A
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
Medicare Part B
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
POS
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
PPO
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
humana - medicare advantage
Workers Comp
I
25141.69
5144.47
5144.47
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
EPO
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
HMO
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
Medicaid
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
Medicare Part A
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
Medicare Part B
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
POS
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
PPO
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
433
null
ms-drg
cirrhosis and alcoholic hepatitis with cc
united healthcare
Workers Comp
I
25141.69
5144.47
7574.88
10629.20
15085.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
EPO
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
HMO
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
Medicaid
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
Medicare Part A
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
Medicare Part B
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
POS
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
PPO
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
blue cross blue shield
Workers Comp
O
3797.24
1075.52
3815.86
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
EPO
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
HMO
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
Medicaid
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
Medicare Part A
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
Medicare Part B
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
POS
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
PPO
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43450
null
cpt
Dilation of esophagus unguided
tricare
Workers Comp
O
3797.24
1075.52
1075.52
3815.86
2278.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
EPO
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
HMO
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
Medicaid
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
Medicare Part A
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
Medicare Part B
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
POS
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
PPO
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
435
null
ms-drg
malignancy of hepatobiliary system or pancreas with mcc
humana - medicare advantage
Workers Comp
I
30140.72
9500.71
9500.71
9500.71
18084.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
EPO
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
HMO
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
Medicaid
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
Medicare Part A
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
Medicare Part B
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
POS
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
PPO
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
436
null
ms-drg
malignancy of hepatobiliary system or pancreas with cc
tricare
Workers Comp
I
31237.38
6511.15
6511.15
6511.15
18742.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
EPO
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
HMO
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
Medicaid
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
Medicare Part A
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
Medicare Part B
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
POS
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
PPO
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43772
null
cpt
Removal of stomach reduction device using an endoscope
humana - medicare advantage
Workers Comp
O
32513.83
41520.44
41520.44
41520.44
19508.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
EPO
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
HMO
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
Medicaid
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
Medicare Part A
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
Medicare Part B
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
POS
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
PPO
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
humana - medicare advantage
Workers Comp
I
25073.55
9539.20
9539.20
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
EPO
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
HMO
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
Medicaid
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
Medicare Part A
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
Medicare Part B
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
POS
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
PPO
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
438
null
ms-drg
disorders of pancreas except malignancy with mcc
tricare
Workers Comp
I
25073.55
9539.20
9806.87
9806.87
15044.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
EPO
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
HMO
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
Medicaid
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
Medicare Part A
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
Medicare Part B
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
POS
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
PPO
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield
Workers Comp
I
21003.65
4924.83
9833.63
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
EPO
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
HMO
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
Medicaid
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
POS
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
PPO
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
blue cross blue shield - medicare advantage
Workers Comp
I
21003.65
4924.83
7178.98
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
EPO
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
HMO
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
Medicaid
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
Medicare Part A
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
Medicare Part B
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
POS
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
PPO
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
humana - medicare advantage
Workers Comp
I
21003.65
4924.83
5487.69
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
EPO
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
HMO
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
Medicaid
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
Medicare Part A
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
Medicare Part B
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
POS
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
PPO
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
tricare
Workers Comp
I
21003.65
4924.83
4924.83
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
EPO
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
HMO
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
Medicaid
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
Medicare Part A
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
Medicare Part B
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
POS
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
PPO
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
va
Workers Comp
I
21003.65
4924.83
5679.36
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
EPO
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
HMO
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
Medicaid
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
Medicare Part A
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
Medicare Part B
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
POS
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
PPO
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
439
null
ms-drg
disorders of pancreas except malignancy with cc
webtpa
Workers Comp
I
21003.65
4924.83
18279.29
18279.29
12602.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
EPO
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
HMO
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
Medicaid
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
Medicare Part A
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
Medicare Part B
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
POS
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
PPO
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
43999
null
cpt
Stomach procedure
humana - medicare advantage
Workers Comp
O
4062.30
573.61
573.61
573.61
2437.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
EPO
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
HMO
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
Medicaid
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
Medicare Part A
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
Medicare Part B
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
POS
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
PPO
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
blue cross blue shield
Workers Comp
I
16766.43
3648.11
6102.15
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
EPO
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
HMO
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
Medicaid
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
Medicare Part A
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
Medicare Part B
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
POS
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
PPO
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
440
null
ms-drg
disorders of pancreas except malignancy without cc/mcc
tricare
Workers Comp
I
16766.43
3648.11
3648.11
6102.15
10059.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
EPO
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
HMO
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
Medicaid
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
Medicare Part A
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
Medicare Part B
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
POS
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
PPO
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
blue cross blue shield
Workers Comp
I
27420.70
10190.37
17799.45
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
EPO
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
HMO
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
Medicaid
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
Medicare Part A
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
Medicare Part B
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
POS
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
PPO
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
humana - medicare advantage
Workers Comp
I
27420.70
10190.37
10190.37
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
EPO
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
HMO
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
Medicaid
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
Medicare Part A
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
Medicare Part B
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
POS
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
PPO
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
441
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with mcc
tricare
Workers Comp
I
27420.70
10190.37
14233.90
17799.45
16452.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
EPO
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
HMO
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
Medicaid
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
Medicare Part A
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
Medicare Part B
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
POS
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
PPO
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
442
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis with cc
humana - medicare advantage
Workers Comp
I
19929.78
5733.68
5733.68
5733.68
11957.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
EPO
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
HMO
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
Medicaid
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
Medicare Part A
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
Medicare Part B
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
POS
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
PPO
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
blue cross blue shield
Workers Comp
I
12924.11
3660.53
8609.76
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
EPO
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
HMO
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
Medicaid
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
Medicare Part A
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
Medicare Part B
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
POS
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
PPO
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
443
null
ms-drg
disorders of liver except malignancy cirrhosis or alcoholic hepatitis without cc/mcc
humana - medicare advantage
Workers Comp
I
12924.11
3660.53
3660.53
8609.76
7754.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
EPO
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
HMO
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
Medicaid
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
Medicare Part A
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
Medicare Part B
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
POS
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
PPO
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
blue cross blue shield
Workers Comp
O
2801.99
702.89
1116.17
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
EPO
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
HMO
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
Medicaid
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
Medicare Part A
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
Medicare Part B
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
POS
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
PPO
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44388
null
cpt
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)
tricare
Workers Comp
O
2801.99
702.89
702.89
1116.17
1681.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
EPO
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
HMO
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
Medicaid
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
Medicare Part A
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
Medicare Part B
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
POS
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
PPO
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
444
null
ms-drg
disorders of the biliary tract with mcc
tricare
Workers Comp
I
34492.90
8700.71
8700.71
8700.71
20695.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
EPO
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
HMO
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
Medicaid
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
Medicare Part A
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
Medicare Part B
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
POS
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
PPO
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
blue cross blue shield
Workers Comp
I
16737.96
5873.83
8690.18
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
EPO
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
HMO
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
Medicaid
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
Medicare Part A
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
Medicare Part B
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
POS
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
PPO
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
humana - medicare advantage
Workers Comp
I
16737.96
5873.83
5873.83
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
EPO
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
HMO
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
Medicaid
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
Medicare Part A
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
Medicare Part B
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
POS
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
PPO
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
445
null
ms-drg
disorders of the biliary tract with cc
va
Workers Comp
I
16737.96
5873.83
13692.52
13692.52
10042.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
EPO
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
HMO
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
Medicaid
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
Medicare Part A
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
Medicare Part B
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
POS
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
PPO
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
446
null
ms-drg
disorders of the biliary tract without cc/mcc
blue cross blue shield
Workers Comp
I
17222.30
9127.94
9127.94
9127.94
10333.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
EPO
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
HMO
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
Medicaid
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
Medicare Part A
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
Medicare Part B
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
POS
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
PPO
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
44970
null
cpt
Removal of appendix using an endoscope
tricare
Workers Comp
O
25223.31
4282.09
4282.09
4282.09
15133.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
EPO
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
HMO
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
Medicaid
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
Medicare Part A
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
Medicare Part B
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
POS
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
PPO
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45130
null
cpt
Repair of prolapsed rectum perineal approach
blue cross blue shield
Workers Comp
O
15252.37
6168.43
6168.43
6168.43
9151.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
EPO
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
HMO
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
Medicaid
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
Medicare Part A
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
Medicare Part B
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
POS
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
PPO
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield
Workers Comp
O
3323.01
689.80
2193.52
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
EPO
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
HMO
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
POS
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
PPO
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
3323.01
689.80
2049.34
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
EPO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
HMO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
Medicaid
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
Medicare Part A
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
Medicare Part B
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
POS
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
PPO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
humana - medicare advantage
Workers Comp
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
EPO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
HMO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
Medicaid
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
Medicare Part A
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
Medicare Part B
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
POS
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
PPO
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45330
null
cpt
Diagnostic examination of the lower portion of the large bowel using an endoscope
tricare
Workers Comp
O
3323.01
689.80
689.80
2193.52
1993.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
EPO
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
HMO
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
Medicaid
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
Medicare Part A
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
Medicare Part B
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
POS
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
PPO
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
blue cross blue shield
Workers Comp
O
3395.01
702.89
2710.95
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
EPO
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
HMO
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
Medicaid
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
Medicare Part A
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
Medicare Part B
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
POS
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
PPO
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
humana - medicare advantage
Workers Comp
O
3395.01
702.89
1034.59
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
EPO
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
HMO
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
Medicaid
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
Medicare Part A
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
Medicare Part B
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
POS
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
PPO
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45331
null
cpt
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)
tricare
Workers Comp
O
3395.01
702.89
702.89
2710.95
2037.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
EPO
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
HMO
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
Medicaid
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
Medicare Part A
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
Medicare Part B
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
POS
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
PPO
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
tricare
Workers Comp
O
3196.95
906.66
918.37
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
EPO
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
HMO
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
Medicaid
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
Medicare Part A
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
Medicare Part B
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
POS
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
PPO
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45350
null
cpt
Banding of hemorrhoids using a flexible endoscope (sigmoidoscope)
va
Workers Comp
O
3196.95
906.66
906.66
918.37
1918.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
EPO
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
HMO
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
Medicaid
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
Medicare Part A
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
Medicare Part B
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
POS
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
PPO
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
aetna
Workers Comp
O
3134.45
702.86
1479.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
EPO
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
HMO
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
Medicaid
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
Medicare Part A
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
Medicare Part B
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
POS
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
PPO
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield
Workers Comp
O
3134.45
702.86
1497.07
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
EPO
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
HMO
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
Medicaid
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
Medicare Part A
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
Medicare Part B
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
POS
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
PPO
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
blue cross blue shield - medicare advantage
Workers Comp
O
3134.45
702.86
1810.27
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
EPO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
HMO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
Medicaid
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
Medicare Part A
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
Medicare Part B
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
POS
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
PPO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
humana - medicare advantage
Workers Comp
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
EPO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
HMO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
Medicaid
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
Medicare Part A
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
Medicare Part B
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
POS
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
PPO
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
tricare
Workers Comp
O
3134.45
702.86
702.89
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
EPO
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
HMO
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
Medicaid
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
Medicare Part A
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
Medicare Part B
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
POS
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
PPO
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
united healthcare
Workers Comp
O
3134.45
702.86
2708.94
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
EPO
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
HMO
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
Medicaid
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
Medicare Part A
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
Medicare Part B
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
POS
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
PPO
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45378
null
cpt
Diagnostic Colonoscopy
va
Workers Comp
O
3134.45
702.86
702.86
2708.94
843.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
EPO
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
HMO
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
Medicaid
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
Medicare Part A
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
Medicare Part B
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
POS
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
PPO
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna
Workers Comp
O
3975.50
918.34
2015.42
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
EPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
HMO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
Medicaid
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
Medicare Part A
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
Medicare Part B
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
POS
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
PPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
aetna - medicare advantage
Workers Comp
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
EPO
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
HMO
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
Medicaid
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
Medicare Part A
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
Medicare Part B
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
POS
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
PPO
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield
Workers Comp
O
3975.50
918.34
1503.51
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
EPO
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
HMO
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
Medicaid
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
Medicare Part A
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
Medicare Part B
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
POS
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
PPO
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
blue cross blue shield - medicare advantage
Workers Comp
O
3975.50
918.34
1559.36
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
EPO
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
HMO
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
Medicaid
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
Medicare Part A
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
Medicare Part B
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
POS
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
PPO
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
geha
Workers Comp
O
3975.50
918.34
3827.21
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
EPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
HMO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
Medicaid
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
Medicare Part A
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
Medicare Part B
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
POS
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
PPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
humana - medicare advantage
Workers Comp
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
EPO
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
HMO
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
Medicaid
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
Medicare Part A
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
Medicare Part B
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
POS
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
PPO
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
medica
Workers Comp
O
3975.50
918.34
1297.80
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
EPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
HMO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
Medicaid
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
Medicare Part A
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
Medicare Part B
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
POS
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
PPO
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
tricare
Workers Comp
O
3975.50
918.34
918.37
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
EPO
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
HMO
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
Medicaid
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
Medicare Part A
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
Medicare Part B
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
POS
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
PPO
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare
Workers Comp
O
3975.50
918.34
3589.03
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
EPO
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
HMO
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
Medicaid
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
Medicare Part A
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
Medicare Part B
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
POS
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
PPO
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
united healthcare - medicare advantage
Workers Comp
O
3975.50
918.34
1052.55
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
EPO
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
HMO
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
Medicaid
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
Medicare Part A
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
Medicare Part B
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
POS
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
PPO
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45380
null
cpt
Colonoscopy w biopsy
va
Workers Comp
O
3975.50
918.34
918.34
3827.21
1102.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
EPO
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
HMO
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
Medicaid
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
Medicare Part A
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
Medicare Part B
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
POS
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
PPO
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield
Workers Comp
O
5679.56
1334.43
4021.12
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
EPO
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
HMO
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicaid
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
POS
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
PPO
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
5679.56
1334.43
1807.86
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
EPO
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
HMO
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
Medicaid
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
Medicare Part A
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
Medicare Part B
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
POS
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
PPO
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
humana - medicare advantage
Workers Comp
O
5679.56
1334.43
1377.56
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
EPO
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
HMO
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
Medicaid
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
Medicare Part A
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
Medicare Part B
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
POS
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
PPO
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
tricare
Workers Comp
O
5679.56
1334.43
1334.43
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
EPO
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
HMO
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
Medicaid
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
Medicare Part A
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
Medicare Part B
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
POS
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
PPO
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45381
null
cpt
Injections beneath lining of large bowel using a flexible endoscope
va
Workers Comp
O
5679.56
1334.43
1377.51
4021.12
3407.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
EPO
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
HMO
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
Medicaid
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
Medicare Part A
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
Medicare Part B
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
POS
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
PPO
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
blue cross blue shield
Workers Comp
O
4616.51
1334.43
2253.68
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
EPO
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
HMO
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
Medicaid
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
Medicare Part A
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
Medicare Part B
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
POS
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
PPO
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45384
null
cpt
Removal of tissue abnormalities tumors or polyps of large bowel by hot biopsy forceps using a flexible endoscope
tricare
Workers Comp
O
4616.51
1334.43
1334.43
2253.68
2769.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
EPO
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
HMO
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
Medicaid
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
Medicare Part A
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
Medicare Part B
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
POS
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
PPO
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna
Workers Comp
O
5144.33
918.34
2545.70
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
EPO
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
HMO
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
Medicaid
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
Medicare Part A
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
Medicare Part B
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
POS
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
PPO
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
aetna - medicare advantage
Workers Comp
O
5144.33
918.34
1307.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
EPO
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
HMO
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
Medicaid
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
Medicare Part A
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
Medicare Part B
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
POS
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
PPO
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield
Workers Comp
O
5144.33
918.34
2657.15
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
EPO
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
HMO
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
Medicaid
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
Medicare Part A
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
Medicare Part B
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
POS
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
PPO
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
blue cross blue shield - medicare advantage
Workers Comp
O
5144.33
918.34
2463.30
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
EPO
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
HMO
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
Medicaid
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
Medicare Part A
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
Medicare Part B
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
POS
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
PPO
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
geha
Workers Comp
O
5144.33
918.34
3827.21
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
EPO
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
HMO
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
Medicaid
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
Medicare Part A
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
Medicare Part B
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
POS
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
PPO
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
humana - medicare advantage
Workers Comp
O
5144.33
918.34
1334.43
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
EPO
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
HMO
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
Medicaid
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
Medicare Part A
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
Medicare Part B
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
POS
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
PPO
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
tricare
Workers Comp
O
5144.33
918.34
1237.74
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
EPO
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
HMO
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
Medicaid
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
Medicare Part A
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
Medicare Part B
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
POS
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
PPO
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
united healthcare
Workers Comp
O
5144.33
918.34
3814.04
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
EPO
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
HMO
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
Medicaid
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
Medicare Part A
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
Medicare Part B
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
POS
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
PPO
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45385
null
cpt
Colonoscopy w polyp removal
va
Workers Comp
O
5144.33
918.34
918.34
3827.21
1485.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
EPO
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
HMO
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
Medicaid
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
Medicare Part A
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
Medicare Part B
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
POS
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
PPO
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45386
null
cpt
Balloon dilation of large bowel using a flexible endoscope
va
Workers Comp
O
5629.93
1377.51
1377.51
1377.51
3377.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
EPO
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
HMO
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
Medicaid
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
Medicare Part A
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
Medicare Part B
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
POS
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
PPO
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield
Workers Comp
O
4095.09
1377.56
3129.37
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
EPO
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
HMO
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
Medicaid
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
Medicare Part A
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
Medicare Part B
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
POS
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
PPO
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
blue cross blue shield - medicare advantage
Workers Comp
O
4095.09
1377.56
2275.99
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
EPO
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
HMO
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
Medicaid
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
Medicare Part A
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
Medicare Part B
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
POS
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
PPO
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45398
null
cpt
Banding of hemorrhoids using a flexible endoscope (colonoscope)
tricare
Workers Comp
O
4095.09
1377.56
1377.56
3129.37
2457.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
EPO
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
HMO
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
Medicaid
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
Medicare Part A
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
Medicare Part B
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
POS
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
PPO
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45399
null
cpt
Large bowel procedure
blue cross blue shield
Workers Comp
O
5887.61
3404.76
3404.76
3404.76
3532.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
EPO
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
HMO
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
Medicaid
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
Medicare Part A
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
Medicare Part B
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
POS
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
PPO
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
459
null
ms-drg
spinal fusion except cervical with mcc
humana - medicare advantage
Workers Comp
I
133007.40
40653.60
40653.60
40653.60
79804.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
EPO
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
HMO
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
Medicaid
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
Medicare Part A
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
Medicare Part B
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
POS
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
PPO
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
45990
null
cpt
Diagnostic examination of anus and rectum under anesthesia
blue cross blue shield
Workers Comp
O
20400.72
5190.31
5190.31
5190.31
12240.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
EPO
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
HMO
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
Medicaid
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
Medicare Part A
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
Medicare Part B
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
POS
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
PPO
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
blue cross blue shield
Workers Comp
I
115839.40
20578.45
45167.63
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
EPO
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
HMO
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
Medicaid
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
Medicare Part A
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
Medicare Part B
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
POS
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
PPO
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
humana - medicare advantage
Workers Comp
I
115839.40
20578.45
22762.41
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
EPO
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
HMO
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
Medicaid
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
Medicare Part A
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
Medicare Part B
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
POS
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
PPO
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
460
null
ms-drg
Spinal fusion
tricare
Workers Comp
I
115839.40
20578.45
20578.45
45167.63
69503.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
EPO
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
HMO
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
Medicaid
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
Medicare Part A
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
Medicare Part B
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
POS
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
PPO
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46080
null
cpt
Incision of sphincter of anus
blue cross blue shield - medicare advantage
Workers Comp
O
16674.32
3663.96
3663.96
3663.96
10004.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
EPO
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
HMO
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
Medicaid
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
Medicare Part A
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
Medicare Part B
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
POS
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
PPO
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46200
null
cpt
Removal of chronic tear (fissure) of anus
humana - medicare advantage
Workers Comp
O
17432.47
2076.66
2076.66
2076.66
10459.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
EPO
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
HMO
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
Medicaid
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
Medicare Part A
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
Medicare Part B
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
POS
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
PPO
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46220
null
cpt
Removal of single external benign growth (papilla or tag) of anus
blue cross blue shield
Workers Comp
O
15087.74
2105.66
2105.66
2105.66
9052.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
EPO
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
HMO
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
Medicaid
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
Medicare Part A
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
Medicare Part B
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
POS
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
PPO
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
blue cross blue shield
Workers Comp
O
4618.31
689.80
2725.52
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
EPO
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
HMO
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
Medicaid
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
Medicare Part A
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
Medicare Part B
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
POS
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
PPO
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
humana - medicare advantage
Workers Comp
O
4618.31
689.80
1068.46
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
EPO
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
HMO
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
Medicaid
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
Medicare Part A
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
Medicare Part B
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
POS
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
PPO
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46221
null
cpt
Removal of external hemorrhoids by rubber banding
tricare
Workers Comp
O
4618.31
689.80
689.80
2725.52
2770.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
EPO
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
HMO
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
Medicaid
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
Medicare Part A
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
Medicare Part B
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
POS
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
PPO
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
blue cross blue shield
Workers Comp
O
17770.87
2163.96
3621.48
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
EPO
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
HMO
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
Medicaid
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
Medicare Part A
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
Medicare Part B
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
POS
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
PPO
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46230
null
cpt
Removal of multiple external benign growths (papillas or tags) of anus
tricare
Workers Comp
O
17770.87
2163.96
2163.96
3621.48
10662.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
EPO
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
HMO
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
Medicaid
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
Medicare Part A
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
Medicare Part B
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
POS
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
PPO
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46250
null
cpt
Removal of multiple external hemorrhoids
tricare
Workers Comp
O
24075.93
2076.66
2076.66
2076.66
14445.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
EPO
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
HMO
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
Medicaid
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
Medicare Part A
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
Medicare Part B
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
POS
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
PPO
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
blue cross blue shield - medicare advantage
Workers Comp
O
14443.46
1557.50
4577.47
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
EPO
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
HMO
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
Medicaid
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
Medicare Part A
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
Medicare Part B
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
POS
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
PPO
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
humana - medicare advantage
Workers Comp
O
14443.46
1557.50
2076.66
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
EPO
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
HMO
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
Medicaid
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
Medicare Part A
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
Medicare Part B
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
POS
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
PPO
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46255
null
cpt
Removal of single external and internal hemorrhoid group
tricare
Workers Comp
O
14443.46
1557.50
1557.50
4577.47
8666.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
EPO
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
HMO
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
Medicaid
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
Medicare Part A
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
Medicare Part B
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
POS
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
PPO
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield
Workers Comp
O
17752.17
2076.66
5336.96
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
EPO
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
HMO
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
Medicaid
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
Medicare Part A
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
Medicare Part B
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
POS
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
PPO
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
blue cross blue shield - medicare advantage
Workers Comp
O
17752.17
2076.66
5181.00
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
EPO
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
HMO
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
Medicaid
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
Medicare Part A
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
Medicare Part B
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
POS
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
PPO
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
tricare
Workers Comp
O
17752.17
2076.66
2076.66
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
EPO
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
HMO
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
Medicaid
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
Medicare Part A
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
Medicare Part B
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
POS
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
PPO
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46260
null
cpt
Removal of multiple internal and external hemorrhoid groups
va
Workers Comp
O
17752.17
2076.66
2163.89
5336.96
10651.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
EPO
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
HMO
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
Medicaid
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
Medicare Part A
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
Medicare Part B
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
POS
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
PPO
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
cigna
Workers Comp
O
15279.00
2076.66
9718.11
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
EPO
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
HMO
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
Medicaid
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
Medicare Part A
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
Medicare Part B
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
POS
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
PPO
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
tricare
Workers Comp
O
15279.00
2076.66
2076.66
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
EPO
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
HMO
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
Medicaid
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
Medicare Part A
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
Medicare Part B
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
POS
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
PPO
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46270
null
cpt
Repair of abnormal anal drainage tract under the skin
va
Workers Comp
O
15279.00
2076.66
2163.89
9718.11
9167.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
EPO
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
HMO
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
Medicaid
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
Medicare Part A
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
Medicare Part B
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
POS
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
PPO
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46275
null
cpt
Repair of anal muscle and abnormal anal drainage tract with the sphincter
tricare
Workers Comp
O
16368.24
2163.96
2163.96
2163.96
9820.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
EPO
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
HMO
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
Medicaid
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
Medicare Part A
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
Medicare Part B
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
POS
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
PPO
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
464
null
ms-drg
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc
humana - medicare advantage
Workers Comp
I
51196.36
13382.22
13382.22
13382.22
30717.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
EPO
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
HMO
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
Medicaid
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
Medicare Part A
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
Medicare Part B
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
POS
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
PPO
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
467
null
ms-drg
revision of hip or knee replacement with cc
humana - medicare advantage
Workers Comp
I
82557.20
21000.82
21000.82
21000.82
49534.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
EPO
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
HMO
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
Medicaid
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
Medicare Part A
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
Medicare Part B
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
POS
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
PPO
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
469
null
ms-drg
major hip and knee joint replacement or reattachment of lower extremity with mcc or total ankle replacement
humana - medicare advantage
Workers Comp
I
102237.56
18840.71
18840.71
18840.71
61342.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
EPO
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
HMO
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
Medicaid
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
Medicare Part A
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
Medicare Part B
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
POS
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
PPO
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
tricare
Workers Comp
O
15725.74
2076.66
2076.66
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
EPO
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
HMO
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
Medicaid
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
Medicare Part A
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
Medicare Part B
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
POS
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
PPO
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46922
null
cpt
Removal of tissue abnormalities of anus
va
Workers Comp
O
15725.74
2076.66
2163.89
2163.89
9435.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
EPO
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
HMO
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
Medicaid
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
Medicare Part A
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
Medicare Part B
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
POS
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
PPO
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
blue cross blue shield
Workers Comp
O
4787.79
2076.66
4879.51
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
EPO
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
HMO
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
Medicaid
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
Medicare Part A
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
Medicare Part B
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
POS
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
PPO
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46946
null
cpt
Tying of multiple internal hemorrhoid groups
tricare
Workers Comp
O
4787.79
2076.66
2076.66
4879.51
2872.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
EPO
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
HMO
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
Medicaid
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
Medicare Part A
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
Medicare Part B
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
POS
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
PPO
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
46947
null
cpt
Stapling of internal hemorrhoid
humana - medicare advantage
Workers Comp
O
18309.73
2076.66
2076.66
2076.66
10985.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
EPO
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
HMO
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
Medicaid
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
Medicare Part A
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
Medicare Part B
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
POS
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
PPO
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
aetna - medicare advantage
Workers Comp
I
68533.40
11438.60
11438.60
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
EPO
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
HMO
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
Medicaid
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
Medicare Part A
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
Medicare Part B
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
POS
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
PPO
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield
Workers Comp
I
68533.40
11438.60
23110.88
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
EPO
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
HMO
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
Medicaid
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
Medicare Part A
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
Medicare Part B
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
POS
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
PPO
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
blue cross blue shield - medicare advantage
Workers Comp
I
68533.40
11438.60
16871.97
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
EPO
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
HMO
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
Medicaid
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
Medicare Part A
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
Medicare Part B
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
POS
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
PPO
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
humana - medicare advantage
Workers Comp
I
68533.40
11438.60
11547.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
EPO
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
HMO
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
Medicaid
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
Medicare Part A
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
Medicare Part B
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
POS
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
PPO
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
tricare
Workers Comp
I
68533.40
11438.60
11634.59
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
EPO
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
HMO
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
Medicaid
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
Medicare Part A
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
Medicare Part B
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
POS
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
PPO
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
va
Workers Comp
I
68533.40
11438.60
12796.10
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
EPO
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
HMO
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
Medicaid
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
Medicare Part A
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
Medicare Part B
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
POS
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
PPO
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
470
null
ms-drg
Major joint replacement (Hip/Knee)
webtpa
Workers Comp
I
68533.40
11438.60
45379.20
45379.20
41120.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
EPO
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
HMO
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
Medicaid
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
Medicare Part A
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
Medicare Part B
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
POS
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
PPO
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
blue cross blue shield
Workers Comp
O
9159.23
1215.96
1860.94
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
EPO
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
HMO
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
Medicaid
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
Medicare Part A
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
Medicare Part B
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
POS
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
PPO
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
humana - medicare advantage
Workers Comp
O
9159.23
1215.96
1215.96
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
EPO
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
HMO
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
Medicaid
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
Medicare Part A
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
Medicare Part B
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
POS
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
PPO
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47000
null
cpt
Needle biopsy of liver accessed through the skin
tricare
Workers Comp
O
9159.23
1215.96
1231.03
1860.94
5495.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
EPO
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
HMO
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
Medicaid
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
Medicare Part A
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
Medicare Part B
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
POS
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
PPO
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
humana - medicare advantage
Workers Comp
I
78556.72
26205.85
30063.68
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
EPO
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
HMO
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
Medicaid
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
Medicare Part A
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
Medicare Part B
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
POS
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
PPO
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
tricare
Workers Comp
I
78556.72
26205.85
26205.85
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
EPO
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
HMO
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
Medicaid
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
Medicare Part A
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
Medicare Part B
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
POS
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
PPO
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
471
null
ms-drg
cervical spinal fusion with mcc
webtpa
Workers Comp
I
78556.72
26205.85
33459.91
33459.91
47134.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
EPO
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
HMO
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
Medicaid
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
Medicare Part A
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
Medicare Part B
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
POS
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
PPO
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
humana - medicare advantage
Workers Comp
I
60807.75
16104.51
17620.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
EPO
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
HMO
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
Medicaid
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
Medicare Part A
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
Medicare Part B
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
POS
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
PPO
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
tricare
Workers Comp
I
60807.75
16104.51
16104.51
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
EPO
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
HMO
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
Medicaid
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
Medicare Part A
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
Medicare Part B
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
POS
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
PPO
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
472
null
ms-drg
cervical spinal fusion with cc
webtpa
Workers Comp
I
60807.75
16104.51
46683.80
46683.80
36484.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
EPO
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
HMO
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
Medicaid
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
Medicare Part A
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
Medicare Part B
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
POS
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
PPO
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield
Workers Comp
I
65127.91
13814.56
25780.50
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
EPO
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
HMO
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
Medicaid
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
Medicare Part A
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
Medicare Part B
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
POS
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
PPO
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
blue cross blue shield - medicare advantage
Workers Comp
I
65127.91
13814.56
19055.80
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
EPO
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
HMO
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
Medicaid
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
Medicare Part A
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
Medicare Part B
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
POS
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
PPO
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
humana - medicare advantage
Workers Comp
I
65127.91
13814.56
13883.92
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
EPO
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
HMO
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
Medicaid
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
Medicare Part A
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
Medicare Part B
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
POS
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
PPO
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
473
null
ms-drg
Cervical spinal fusion
tricare
Workers Comp
I
65127.91
13814.56
13814.56
25780.50
39076.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
EPO
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
HMO
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
Medicaid
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
Medicare Part A
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
Medicare Part B
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
POS
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
PPO
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47379
null
cpt
Liver procedure using an endoscope
humana - medicare advantage
Workers Comp
O
23507.21
3425.67
3425.67
3425.67
14104.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
EPO
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
HMO
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
Medicaid
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
Medicare Part A
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
Medicare Part B
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
POS
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
PPO
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
aetna - medicare advantage
Workers Comp
O
22678.85
4282.09
4381.91
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
EPO
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
HMO
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
Medicaid
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
Medicare Part A
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
Medicare Part B
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
POS
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
PPO
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield
Workers Comp
O
22678.85
4282.09
8911.15
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
EPO
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
HMO
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
Medicaid
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
POS
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
PPO
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
22678.85
4282.09
7603.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
EPO
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
HMO
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
Medicaid
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
Medicare Part A
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
Medicare Part B
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
POS
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
PPO
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
humana - medicare advantage
Workers Comp
O
22678.85
4282.09
4481.73
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
EPO
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
HMO
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
Medicaid
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
Medicare Part A
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
Medicare Part B
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
POS
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
PPO
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
tricare
Workers Comp
O
22678.85
4282.09
4282.09
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
EPO
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
HMO
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
Medicaid
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
Medicare Part A
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
Medicare Part B
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
POS
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
PPO
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
united healthcare
Workers Comp
O
22678.85
4282.09
17009.14
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
EPO
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
HMO
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
Medicaid
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
Medicare Part A
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
Medicare Part B
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
POS
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
PPO
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47562
null
cpt
Gallbladder removal using endoscope
va
Workers Comp
O
22678.85
4282.09
4481.58
17009.14
5138.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
EPO
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
HMO
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
Medicaid
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
Medicare Part A
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
Medicare Part B
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
POS
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
PPO
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
aetna
Workers Comp
O
21733.21
4282.09
12544.52
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
EPO
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
HMO
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
Medicaid
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
Medicare Part A
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
Medicare Part B
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
POS
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
PPO
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield
Workers Comp
O
21733.21
4282.09
10083.56
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
EPO
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
HMO
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
Medicaid
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
POS
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
PPO
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
21733.21
4282.09
8509.31
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
EPO
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
HMO
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
Medicaid
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
Medicare Part A
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
Medicare Part B
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
POS
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
PPO
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
cigna
Workers Comp
O
21733.21
4282.09
16527.36
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
EPO
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
HMO
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
Medicaid
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
Medicare Part A
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
Medicare Part B
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
POS
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
PPO
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
humana - medicare advantage
Workers Comp
O
21733.21
4282.09
4282.09
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
EPO
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
HMO
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
Medicaid
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
Medicare Part A
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
Medicare Part B
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
POS
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
PPO
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
tricare
Workers Comp
O
21733.21
4282.09
4381.91
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
EPO
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
HMO
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
Medicaid
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
Medicare Part A
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
Medicare Part B
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
POS
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
PPO
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
united healthcare
Workers Comp
O
21733.21
4282.09
16237.85
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
EPO
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
HMO
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
Medicaid
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
Medicare Part A
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
Medicare Part B
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
POS
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
PPO
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47563
null
cpt
Removal of gallbladder with X-ray study of bile ducts using endoscope
va
Workers Comp
O
21733.21
4282.09
4481.58
16527.36
13039.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
EPO
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
HMO
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
Medicaid
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
Medicare Part A
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
Medicare Part B
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
POS
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
PPO
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
476
null
ms-drg
amputation for musculoskeletal system and connective tissue disorders without cc/mcc
humana - medicare advantage
Workers Comp
I
50003.13
7700.21
7700.21
7700.21
30001.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
EPO
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
HMO
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
Medicaid
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
Medicare Part A
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
Medicare Part B
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
POS
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
PPO
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
47600
null
cpt
Removal of gallbladder
aetna - medicare advantage
Workers Comp
I
83655.17
24921.37
24921.37
24921.37
50193.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
EPO
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
HMO
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
Medicaid
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
POS
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
PPO
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
477
null
ms-drg
biopsies of musculoskeletal system and connective tissue with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
151194.13
44722.36
44722.36
44722.36
90716.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
EPO
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
HMO
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
Medicaid
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
Medicare Part A
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
Medicare Part B
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
POS
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
PPO
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
480
null
ms-drg
hip and femur procedures except major joint with mcc
humana - medicare advantage
Workers Comp
I
67372.96
18534.52
18534.52
18534.52
40423.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
EPO
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
HMO
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
Medicaid
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
Medicare Part A
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
Medicare Part B
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
POS
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
PPO
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
aetna - medicare advantage
Workers Comp
I
63278.75
12770.33
12960.51
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
EPO
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
HMO
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
Medicaid
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
Medicare Part A
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
Medicare Part B
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
POS
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
PPO
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
blue cross blue shield
Workers Comp
I
63278.75
12770.33
21334.37
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
EPO
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
HMO
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
Medicaid
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
Medicare Part A
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
Medicare Part B
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
POS
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
PPO
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
humana - medicare advantage
Workers Comp
I
63278.75
12770.33
12770.33
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
EPO
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
HMO
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
Medicaid
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
Medicare Part A
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
Medicare Part B
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
POS
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
PPO
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
tricare
Workers Comp
I
63278.75
12770.33
15043.00
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
EPO
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
HMO
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
Medicaid
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
Medicare Part A
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
Medicare Part B
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
POS
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
PPO
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
united healthcare - medicare advantage
Workers Comp
I
63278.75
12770.33
12915.69
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
EPO
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
HMO
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
Medicaid
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
Medicare Part A
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
Medicare Part B
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
POS
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
PPO
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
481
null
ms-drg
hip and femur procedures except major joint with cc
webtpa - medicare advantage
Workers Comp
I
63278.75
12770.33
30785.58
30785.58
37967.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
POS
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
42134.28
9577.68
18778.50
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
EPO
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
HMO
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
Medicaid
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
Medicare Part A
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
Medicare Part B
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
POS
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
PPO
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
humana - medicare advantage
Workers Comp
I
42134.28
9577.68
9577.68
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
EPO
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
HMO
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
Medicaid
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
Medicare Part A
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
Medicare Part B
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
POS
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
PPO
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
482
null
ms-drg
hip and femur procedures except major joint without cc/mcc
tricare
Workers Comp
I
42134.28
9577.68
10482.79
18778.50
25280.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
EPO
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
HMO
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
Medicaid
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
Medicare Part A
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
Medicare Part B
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
POS
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
PPO
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
aetna - medicare advantage
Workers Comp
I
74378.35
14258.73
15725.84
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
EPO
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
HMO
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
Medicaid
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
Medicare Part A
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
Medicare Part B
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
POS
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
PPO
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
blue cross blue shield
Workers Comp
I
74378.35
14258.73
22332.70
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
EPO
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
HMO
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
Medicaid
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
Medicare Part A
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
Medicare Part B
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
POS
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
PPO
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
humana - medicare advantage
Workers Comp
I
74378.35
14258.73
14258.73
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
EPO
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
HMO
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
Medicaid
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
Medicare Part A
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
Medicare Part B
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
POS
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
PPO
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
483
null
ms-drg
major joint or limb reattachment procedures of upper extremities
va
Workers Comp
I
74378.35
14258.73
14621.34
22332.70
44627.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
EPO
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
HMO
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
Medicaid
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
Medicare Part A
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
Medicare Part B
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
POS
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
PPO
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
487
null
ms-drg
knee procedures with principal diagnosis of infection without cc/mcc
blue cross blue shield
Workers Comp
I
34772.98
19088.23
19088.23
19088.23
20863.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
EPO
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
HMO
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
Medicaid
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
Medicare Part A
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
Medicare Part B
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
POS
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
PPO
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
blue cross blue shield
Workers Comp
O
2498.05
742.65
2151.53
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
EPO
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
HMO
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
Medicaid
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
Medicare Part A
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
Medicare Part B
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
POS
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
PPO
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
united healthcare
Workers Comp
O
2498.05
742.65
1549.34
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
EPO
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
HMO
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
Medicaid
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
Medicare Part A
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
Medicare Part B
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
POS
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
PPO
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49083
null
cpt
Drainage of fluid from abdominal cavity using imaging guidance
va
Workers Comp
O
2498.05
742.65
742.65
2151.53
1498.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
EPO
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
HMO
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
Medicaid
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
Medicare Part A
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
Medicare Part B
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
POS
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
PPO
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49180
null
cpt
Needle biopsy of abdominal cavity growth accessed through the skin
blue cross blue shield
Workers Comp
O
7794.20
1567.18
1567.18
1567.18
4676.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
EPO
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
HMO
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
Medicaid
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
Medicare Part A
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
Medicare Part B
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
POS
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
PPO
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
humana - medicare advantage
Workers Comp
I
73549.17
15851.50
15851.50
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
EPO
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
HMO
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
Medicaid
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
Medicare Part A
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
Medicare Part B
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
POS
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
PPO
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
492
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with mcc
medica
Workers Comp
I
73549.17
15851.50
27744.90
27744.90
44129.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
EPO
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
HMO
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
Medicaid
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
Medicare Part A
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
Medicare Part B
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
POS
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
PPO
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
humana - medicare advantage
Workers Comp
I
55581.66
14187.15
14187.15
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
EPO
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
HMO
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
Medicaid
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
Medicare Part A
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
Medicare Part B
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
POS
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
PPO
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
493
null
ms-drg
lower extremity and humerus procedures except hip foot and femur with cc
tricare
Workers Comp
I
55581.66
14187.15
16075.34
16075.34
33349.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
EPO
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
HMO
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
Medicaid
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
Medicare Part A
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
Medicare Part B
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
POS
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
PPO
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
aetna
Workers Comp
O
20217.61
4282.09
24397.19
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
EPO
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
HMO
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
Medicaid
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
Medicare Part A
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
Medicare Part B
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
POS
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
PPO
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield
Workers Comp
O
20217.61
4282.09
7499.76
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
EPO
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
HMO
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
POS
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
PPO
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
20217.61
4282.09
4334.81
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
EPO
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
HMO
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
Medicaid
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
Medicare Part A
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
Medicare Part B
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
POS
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
PPO
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49320
null
cpt
Diagnostic examination of the abdomen using an endoscope
humana - medicare advantage
Workers Comp
O
20217.61
4282.09
4282.09
24397.19
12130.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
EPO
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
HMO
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
Medicaid
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
Medicare Part A
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
Medicare Part B
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
POS
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
PPO
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
blue cross blue shield
Workers Comp
O
26555.63
6997.25
6997.25
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
EPO
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
HMO
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
Medicaid
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
Medicare Part A
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
Medicare Part B
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
POS
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
PPO
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49321
null
cpt
Biopsy of abdomen using an endoscope
tricare
Workers Comp
O
26555.63
6997.25
7453.01
7453.01
15933.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
EPO
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
HMO
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
Medicaid
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
Medicare Part A
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
Medicare Part B
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
POS
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
PPO
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
tricare
Workers Comp
O
29842.55
6085.54
6085.54
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
EPO
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
HMO
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
Medicaid
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
Medicare Part A
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
Medicare Part B
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
POS
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
PPO
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49322
null
cpt
Aspiration of abdominal cavity or cyst using an endoscope
va
Workers Comp
O
29842.55
6085.54
7688.02
7688.02
17905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
EPO
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
HMO
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
POS
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
PPO
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
18609.64
4282.09
8160.59
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
EPO
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
HMO
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
Medicaid
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
Medicare Part A
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
Medicare Part B
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
POS
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
PPO
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
humana - medicare advantage
Workers Comp
O
18609.64
4282.09
4381.91
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
EPO
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
HMO
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
Medicaid
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
Medicare Part A
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
Medicare Part B
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
POS
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
PPO
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49324
null
cpt
Insertion of abdominal cavity catheter using an endoscope
tricare
Workers Comp
O
18609.64
4282.09
4282.09
8160.59
11165.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
EPO
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
HMO
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
Medicaid
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
Medicare Part A
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
Medicare Part B
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
POS
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
PPO
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49325
null
cpt
Revision of abdominal cavity catheter using an endoscope
tricare
Workers Comp
O
20800.82
7888.98
7888.98
7888.98
12480.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
EPO
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
HMO
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
Medicaid
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
Medicare Part A
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
Medicare Part B
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
POS
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
PPO
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield
Workers Comp
O
26182.92
4282.09
5994.72
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
EPO
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
HMO
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
POS
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
PPO
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
26182.92
4282.09
7794.41
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
EPO
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
HMO
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
Medicaid
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
Medicare Part A
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
Medicare Part B
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
POS
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
PPO
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
humana - medicare advantage
Workers Comp
O
26182.92
4282.09
4282.09
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
EPO
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
HMO
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
Medicaid
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
Medicare Part A
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
Medicare Part B
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
POS
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
PPO
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
tricare
Workers Comp
O
26182.92
4282.09
7888.98
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
EPO
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
HMO
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
Medicaid
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
Medicare Part A
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
Medicare Part B
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
POS
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
PPO
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49329
null
cpt
Procedure on abdomen using an endoscope
va
Workers Comp
O
26182.92
4282.09
7888.71
7888.98
15709.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
EPO
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
HMO
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
Medicaid
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
Medicare Part A
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
Medicare Part B
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
POS
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
PPO
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
blue cross blue shield
Workers Comp
I
57965.22
10450.17
19757.25
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
EPO
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
HMO
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
Medicaid
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
Medicare Part A
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
Medicare Part B
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
POS
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
PPO
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
tricare
Workers Comp
I
57965.22
10450.17
10450.17
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
EPO
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
HMO
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
Medicaid
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
Medicare Part A
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
Medicare Part B
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
POS
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
PPO
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
united healthcare
Workers Comp
I
57965.22
10450.17
33138.65
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
EPO
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
HMO
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
Medicaid
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
Medicare Part A
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
Medicare Part B
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
POS
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
PPO
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
494
null
ms-drg
lower extremity and humerus procedures except hip foot and femur without cc/mcc
worker comp
Workers Comp
I
57965.22
10450.17
16794.54
33138.65
34779.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
EPO
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
HMO
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
Medicaid
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
Medicare Part A
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
Medicare Part B
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
POS
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
PPO
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49402
null
cpt
Removal of foreign body from abdominal cavity
aetna
Workers Comp
O
42363.98
24397.19
24397.19
24397.19
25418.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
EPO
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
HMO
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
Medicaid
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
Medicare Part A
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
Medicare Part B
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
POS
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
PPO
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49406
null
cpt
Fluid collection drainage of the abdominal region by catheter using imaging guidance accessed through the skin
humana - medicare advantage
Workers Comp
O
8796.80
1246.10
1246.10
1246.10
5278.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
EPO
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
HMO
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
Medicaid
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
Medicare Part A
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
Medicare Part B
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
POS
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
PPO
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
humana - medicare advantage
Workers Comp
O
16959.83
2754.50
2754.50
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
EPO
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
HMO
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
Medicaid
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
Medicare Part A
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
Medicare Part B
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
POS
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
PPO
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49505
null
cpt
Hernia repair older than 5 years
united healthcare - medicare advantage
Workers Comp
O
16959.83
2754.50
5233.55
5233.55
10175.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
EPO
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
HMO
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
Medicaid
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
Medicare Part A
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
Medicare Part B
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
POS
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
PPO
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
blue cross blue shield
Workers Comp
O
26565.66
2819.36
6128.54
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
EPO
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
HMO
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
Medicaid
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
Medicare Part A
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
Medicare Part B
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
POS
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
PPO
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49520
null
cpt
Repair of groin (inguinal) hernia that is not trapped
tricare
Workers Comp
O
26565.66
2819.36
2819.36
6128.54
15939.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
EPO
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
HMO
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
Medicaid
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
Medicare Part A
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
Medicare Part B
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
POS
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
PPO
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
blue cross blue shield - medicare advantage
Workers Comp
O
18499.66
2524.36
4334.81
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
EPO
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
HMO
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
Medicaid
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
Medicare Part A
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
Medicare Part B
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
POS
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
PPO
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
humana - medicare advantage
Workers Comp
O
18499.66
2524.36
2524.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
EPO
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
HMO
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
Medicaid
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
Medicare Part A
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
Medicare Part B
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
POS
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
PPO
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49560
null
cpt
Repair of incisional or abdominal hernia initial or primary not trapped
tricare
Workers Comp
O
18499.66
2524.36
2819.36
4334.81
11099.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
EPO
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
HMO
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
Medicaid
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
Medicare Part A
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
Medicare Part B
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
POS
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
PPO
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
blue cross blue shield
Workers Comp
O
24122.43
4282.09
7214.36
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
EPO
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
HMO
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
Medicaid
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
Medicare Part A
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
Medicare Part B
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
POS
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
PPO
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49565
null
cpt
Repair of incisional or abdominal hernia recurrent of secondary not trapped
tricare
Workers Comp
O
24122.43
4282.09
4282.09
7214.36
14473.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
EPO
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
HMO
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
Medicaid
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
Medicare Part A
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
Medicare Part B
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
POS
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
PPO
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield
Workers Comp
O
23307.48
4334.81
7264.27
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
EPO
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
HMO
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
Medicaid
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
POS
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
PPO
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49568
null
cpt
Placement of mesh to repair incisional or abdominal hernia open procedure
blue cross blue shield - medicare advantage
Workers Comp
O
23307.48
4334.81
4334.81
7264.27
13984.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
EPO
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
HMO
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
Medicaid
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
Medicare Part A
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
Medicare Part B
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
POS
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
PPO
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield
Workers Comp
O
17609.25
2786.93
6508.00
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
EPO
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
HMO
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
Medicaid
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
Medicare Part A
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
Medicare Part B
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
POS
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
PPO
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
blue cross blue shield - medicare advantage
Workers Comp
O
17609.25
2786.93
6338.31
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
EPO
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
HMO
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
Medicaid
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
Medicare Part A
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
Medicare Part B
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
POS
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
PPO
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
tricare
Workers Comp
O
17609.25
2786.93
2786.93
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
EPO
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
HMO
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
Medicaid
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
Medicare Part A
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
Medicare Part B
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
POS
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
PPO
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49585
null
cpt
Repair of hernia at navel patient age 5 years or older
va
Workers Comp
O
17609.25
2786.93
2819.26
6508.00
10565.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
EPO
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
HMO
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
Medicaid
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
Medicare Part A
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
Medicare Part B
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
POS
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
PPO
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49587
null
cpt
Repair of trapped hernia at navel patient age 5 years or older
blue cross blue shield
Workers Comp
O
19620.93
7772.02
7772.02
7772.02
11772.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
EPO
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
HMO
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
Medicaid
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
Medicare Part A
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
Medicare Part B
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
POS
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
PPO
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield
Workers Comp
O
25395.95
4282.09
8257.01
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
EPO
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
HMO
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
POS
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
PPO
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
25395.95
4282.09
7672.18
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
EPO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
HMO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
Medicaid
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
Medicare Part A
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
Medicare Part B
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
POS
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
PPO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
humana - medicare advantage
Workers Comp
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
EPO
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
HMO
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
Medicaid
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
Medicare Part A
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
Medicare Part B
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
POS
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
PPO
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
tricare
Workers Comp
O
25395.95
4282.09
4481.73
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
EPO
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
HMO
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
Medicaid
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
Medicare Part A
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
Medicare Part B
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
POS
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
PPO
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare
Workers Comp
O
25395.95
4282.09
19046.96
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
EPO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
HMO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
Medicaid
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
Medicare Part A
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
Medicare Part B
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
POS
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
PPO
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
united healthcare - medicare advantage
Workers Comp
O
25395.95
4282.09
4282.09
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
EPO
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
HMO
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
Medicaid
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
Medicare Part A
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
Medicare Part B
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
POS
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
PPO
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49650
null
cpt
Repair of groin hernia using an endoscope
va
Workers Comp
O
25395.95
4282.09
4424.57
19046.96
15237.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
EPO
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
HMO
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
Medicaid
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
Medicare Part A
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
Medicare Part B
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
POS
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
PPO
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield
Workers Comp
O
31395.56
4264.98
10496.65
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
EPO
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
HMO
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
POS
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
PPO
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
31395.56
4264.98
8920.51
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
EPO
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
HMO
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
Medicaid
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
Medicare Part A
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
Medicare Part B
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
POS
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
PPO
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
tricare
Workers Comp
O
31395.56
4264.98
4481.73
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
EPO
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
HMO
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
Medicaid
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
Medicare Part A
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
Medicare Part B
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
POS
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
PPO
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49651
null
cpt
Repositioning of recurrent groin hernia using an endoscope
va
Workers Comp
O
31395.56
4264.98
4264.98
10496.65
18837.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
EPO
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
HMO
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
Medicaid
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
Medicare Part A
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
Medicare Part B
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
POS
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
PPO
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield
Workers Comp
O
24962.49
4481.58
7918.70
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
EPO
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
HMO
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
POS
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
PPO
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
24962.49
4481.58
7667.23
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
EPO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
HMO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
Medicaid
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
Medicare Part A
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
Medicare Part B
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
POS
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
PPO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
humana - medicare advantage
Workers Comp
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
EPO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
HMO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
Medicaid
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
Medicare Part A
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
Medicare Part B
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
POS
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
PPO
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
tricare
Workers Comp
O
24962.49
4481.58
4481.73
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
EPO
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
HMO
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
Medicaid
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
Medicare Part A
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
Medicare Part B
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
POS
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
PPO
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49652
null
cpt
Repair of hernia using an endoscope
va
Workers Comp
O
24962.49
4481.58
4481.58
7918.70
14977.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
EPO
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
HMO
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
Medicaid
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
Medicare Part A
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
Medicare Part B
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
POS
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
PPO
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
blue cross blue shield
Workers Comp
O
30451.33
4282.09
10485.80
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
EPO
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
HMO
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
Medicaid
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
Medicare Part A
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
Medicare Part B
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
POS
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
PPO
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49653
null
cpt
Repair of trapped hernia using an endoscope
humana - medicare advantage
Workers Comp
O
30451.33
4282.09
4282.09
10485.80
18270.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
EPO
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
HMO
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
Medicaid
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
Medicare Part A
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
Medicare Part B
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
POS
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
PPO
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield
Workers Comp
O
27536.59
7309.85
7580.03
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
EPO
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
HMO
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
Medicaid
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
Medicare Part A
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
Medicare Part B
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
POS
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
PPO
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
blue cross blue shield - medicare advantage
Workers Comp
O
27536.59
7309.85
7600.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
EPO
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
HMO
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
Medicaid
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
Medicare Part A
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
Medicare Part B
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
POS
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
PPO
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
humana - medicare advantage
Workers Comp
O
27536.59
7309.85
7309.85
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
EPO
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
HMO
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
Medicaid
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
Medicare Part A
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
Medicare Part B
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
POS
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
PPO
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49654
null
cpt
Repair of incisional hernia using an endoscope initial or primary
tricare
Workers Comp
O
27536.59
7309.85
7888.98
7888.98
16521.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
EPO
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
HMO
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
Medicaid
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
Medicare Part A
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
Medicare Part B
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
POS
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
PPO
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield
Workers Comp
O
28943.80
7794.41
10646.05
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
EPO
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
HMO
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
Medicaid
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
Medicare Part A
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
Medicare Part B
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
POS
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
PPO
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49655
null
cpt
Repair of trapped incisional hernia using an endoscope primary
blue cross blue shield - medicare advantage
Workers Comp
O
28943.80
7794.41
7794.41
10646.05
17366.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
EPO
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
HMO
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
Medicaid
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
Medicare Part A
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
Medicare Part B
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
POS
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
PPO
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49656
null
cpt
Repair of incisional hernia using an endoscope recurrent of secondary
humana - medicare advantage
Workers Comp
O
31478.83
7888.98
7888.98
7888.98
18887.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
EPO
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
HMO
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
Medicaid
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
Medicare Part A
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
Medicare Part B
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
POS
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
PPO
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
49999
null
cpt
Abdominal procedure
tricare
Workers Comp
O
18283.83
696.23
696.23
696.23
10970.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
EPO
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
HMO
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
Medicaid
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
Medicare Part A
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
Medicare Part B
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
POS
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
PPO
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
500
null
ms-drg
soft tissue procedures with mcc
united healthcare
Workers Comp
I
57713.05
14170.30
14170.30
14170.30
34627.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
EPO
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
HMO
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
Medicaid
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
Medicare Part A
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
Medicare Part B
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
POS
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
PPO
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
501
null
ms-drg
soft tissue procedures with cc
tricare
Workers Comp
I
40855.67
10612.46
10612.46
10612.46
24513.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
EPO
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
HMO
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
Medicaid
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
Medicare Part A
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
Medicare Part B
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
POS
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
PPO
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
blue cross blue shield
Workers Comp
O
8742.56
1160.73
1160.73
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
EPO
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
HMO
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
Medicaid
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
Medicare Part A
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
Medicare Part B
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
POS
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
PPO
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
tricare
Workers Comp
O
8742.56
1160.73
1215.96
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
EPO
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
HMO
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
Medicaid
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
Medicare Part A
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
Medicare Part B
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
POS
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
PPO
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50200
null
cpt
Needle biopsy of kidney accessed through the skin
united healthcare
Workers Comp
O
8742.56
1160.73
6110.48
6110.48
5245.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
EPO
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
HMO
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
Medicaid
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
Medicare Part A
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
Medicare Part B
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
POS
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
PPO
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50433
null
cpt
Placement of catheter of kidney and urinary tube (ureter) accessed through the skin using imaging guidance with radiological supervision and interpretation
blue cross blue shield
Workers Comp
O
7089.07
3620.80
3620.80
3620.80
4253.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
EPO
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
HMO
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
Medicaid
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
Medicare Part A
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
Medicare Part B
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
POS
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
PPO
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50544
null
cpt
Repair of kidney using an endoscope
united healthcare
Workers Comp
O
37064.60
27798.45
27798.45
27798.45
22238.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
EPO
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
HMO
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
Medicaid
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
Medicare Part A
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
Medicare Part B
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
POS
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
PPO
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield
Workers Comp
O
21414.09
2674.06
8108.57
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
EPO
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
HMO
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
Medicaid
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
Medicare Part A
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
Medicare Part B
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
POS
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
PPO
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
blue cross blue shield - medicare advantage
Workers Comp
O
21414.09
2674.06
9526.14
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
EPO
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
HMO
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
Medicaid
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
Medicare Part A
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
Medicare Part B
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
POS
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
PPO
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
humana - medicare advantage
Workers Comp
O
21414.09
2674.06
2724.53
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
EPO
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
HMO
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
Medicaid
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
Medicare Part A
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
Medicare Part B
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
POS
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
PPO
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
tricare
Workers Comp
O
21414.09
2674.06
2674.06
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
EPO
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
HMO
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
Medicaid
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
Medicare Part A
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
Medicare Part B
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
POS
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
PPO
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
50590
null
cpt
Shock wave crushing of kidney stones
va
Workers Comp
O
21414.09
2674.06
2724.44
9526.14
12848.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
EPO
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
HMO
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
Medicaid
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
Medicare Part A
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
Medicare Part B
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
POS
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
PPO
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51102
null
cpt
Aspiration of bladder with insertion of bladder tube to skin surface
blue cross blue shield - medicare advantage
Workers Comp
O
12730.35
5364.66
5364.66
5364.66
7638.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
EPO
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
HMO
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
Medicaid
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
Medicare Part A
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
Medicare Part B
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
POS
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
PPO
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
516
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures with cc
tricare
Workers Comp
I
54493.54
13074.37
13074.37
13074.37
32696.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
EPO
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
HMO
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
Medicaid
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
Medicare Part A
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
Medicare Part B
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
POS
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
PPO
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
humana - medicare advantage
Workers Comp
O
2560.34
205.13
338.27
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
EPO
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
HMO
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
Medicaid
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
Medicare Part A
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
Medicare Part B
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
POS
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
PPO
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
tricare
Workers Comp
O
2560.34
205.13
205.13
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
EPO
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
HMO
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
Medicaid
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
Medicare Part A
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
Medicare Part B
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
POS
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
PPO
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51600
null
cpt
Injection procedure for X-ray imaging of the bladder or during voiding
va
Workers Comp
O
2560.34
205.13
366.82
366.82
1536.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
EPO
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
HMO
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
Medicaid
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
Medicare Part A
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
Medicare Part B
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
POS
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
PPO
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
aetna - medicare advantage
Workers Comp
I
29174.94
9162.96
9162.96
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
EPO
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
HMO
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
Medicaid
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
Medicare Part A
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
Medicare Part B
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
POS
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
PPO
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
517
null
ms-drg
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc
tricare
Workers Comp
I
29174.94
9162.96
9446.71
9446.71
17504.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
EPO
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
HMO
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
Medicaid
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
Medicare Part A
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
Medicare Part B
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
POS
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
PPO
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51702
null
cpt
Insertion of indwelling bladder catheter simple
humana - medicare advantage
Workers Comp
O
20292.50
2102.20
2102.20
2102.20
12175.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
EPO
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
HMO
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
Medicaid
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
Medicare Part A
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
Medicare Part B
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
POS
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
PPO
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
51720
null
cpt
Instillation of anti-cancer drug into bladder
humana - medicare advantage
Workers Comp
O
18554.99
3236.62
3236.62
3236.62
11132.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
EPO
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
HMO
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
Medicaid
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
Medicare Part A
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
Medicare Part B
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
POS
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
PPO
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
518
null
ms-drg
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator
tricare
Workers Comp
I
105650.30
14166.16
14166.16
14166.16
63390.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
EPO
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
HMO
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
Medicaid
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
Medicare Part A
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
Medicare Part B
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
POS
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
PPO
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
519
null
ms-drg
back and neck procedures except spinal fusion with cc
webtpa
Workers Comp
I
48712.80
36370.92
36370.92
36370.92
29227.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
EPO
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
HMO
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
Medicaid
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
Medicare Part A
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
Medicare Part B
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
POS
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
PPO
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
blue cross blue shield
Workers Comp
I
35372.50
8980.21
12494.82
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
EPO
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
HMO
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
Medicaid
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
Medicare Part A
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
Medicare Part B
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
POS
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
PPO
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
humana - medicare advantage
Workers Comp
I
35372.50
8980.21
9035.39
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
EPO
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
HMO
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
Medicaid
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
Medicare Part A
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
Medicare Part B
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
POS
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
PPO
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
tricare
Workers Comp
I
35372.50
8980.21
9087.23
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
EPO
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
HMO
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
Medicaid
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
Medicare Part A
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
Medicare Part B
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
POS
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
PPO
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
520
null
ms-drg
back and neck procedures except spinal fusion without cc/mcc
va
Workers Comp
I
35372.50
8980.21
8980.21
12494.82
21223.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
EPO
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
HMO
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
Medicaid
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
Medicare Part A
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
Medicare Part B
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
POS
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
PPO
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52001
null
cpt
Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope
tricare
Workers Comp
O
54459.72
3909.13
3909.13
3909.13
32675.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
EPO
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
HMO
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
Medicaid
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
Medicare Part A
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
Medicare Part B
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
POS
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
PPO
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
aetna - medicare advantage
Workers Comp
O
15147.20
1569.38
2133.11
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
EPO
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
HMO
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
Medicaid
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
Medicare Part A
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
Medicare Part B
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
POS
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
PPO
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
blue cross blue shield
Workers Comp
O
15147.20
1569.38
4734.64
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
EPO
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
HMO
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
Medicaid
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
Medicare Part A
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
Medicare Part B
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
POS
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
PPO
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
humana - medicare advantage
Workers Comp
O
15147.20
1569.38
1578.66
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
EPO
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
HMO
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
Medicaid
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
Medicare Part A
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
Medicare Part B
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
POS
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
PPO
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52005
null
cpt
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area
tricare
Workers Comp
O
15147.20
1569.38
1569.38
4734.64
9088.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
EPO
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
HMO
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
Medicaid
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
Medicare Part A
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
Medicare Part B
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
POS
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
PPO
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52007
null
cpt
Insertion of catheter into urinary duct (ureter) and biopsy of urinary duct and/or renal pelvis using an endoscope
va
Workers Comp
O
22649.97
2724.44
2724.44
2724.44
13589.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
EPO
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
HMO
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
Medicaid
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
Medicare Part A
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
Medicare Part B
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
POS
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
PPO
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
521
null
ms-drg
hip replacement with principal diagnosis of hip fracture with mcc
humana - medicare advantage
Workers Comp
I
77967.00
16422.23
16422.23
16422.23
46780.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
EPO
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
HMO
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
Medicaid
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
Medicare Part A
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
Medicare Part B
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
POS
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
PPO
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
522
null
ms-drg
hip replacement with principal diagnosis of hip fracture without mcc
humana - medicare advantage
Workers Comp
I
70354.37
13123.24
13123.24
13123.24
42212.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
EPO
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
HMO
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
Medicaid
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
Medicare Part A
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
Medicare Part B
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
POS
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
PPO
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
aetna - medicare advantage
Workers Comp
O
14749.24
1587.94
2724.53
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
EPO
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
HMO
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
Medicaid
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
Medicare Part A
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
Medicare Part B
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
POS
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
PPO
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52204
null
cpt
Biopsy of the bladder using an endoscope
tricare
Workers Comp
O
14749.24
1587.94
1587.94
2724.53
8849.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
EPO
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
HMO
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
Medicaid
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
Medicare Part A
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
Medicare Part B
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
POS
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
PPO
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52224
null
cpt
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope
tricare
Workers Comp
O
16104.46
1569.38
1569.38
1569.38
9662.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
EPO
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
HMO
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
Medicaid
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
Medicare Part A
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
Medicare Part B
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
POS
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
PPO
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
humana - medicare advantage
Workers Comp
O
15764.84
2524.01
2724.53
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
EPO
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
HMO
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
Medicaid
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
Medicare Part A
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
Medicare Part B
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
POS
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
PPO
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
tricare
Workers Comp
O
15764.84
2524.01
2524.01
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
EPO
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
HMO
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
Medicaid
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
Medicare Part A
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
Medicare Part B
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
POS
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
PPO
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52234
null
cpt
Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope
va
Workers Comp
O
15764.84
2524.01
2724.44
2724.53
9458.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
EPO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
HMO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
Medicaid
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
Medicare Part A
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
Medicare Part B
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
POS
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
PPO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
aetna - medicare advantage
Workers Comp
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
EPO
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
HMO
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
Medicaid
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
Medicare Part A
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
Medicare Part B
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
POS
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
PPO
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
blue cross blue shield
Workers Comp
O
17312.24
2724.53
4856.39
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
EPO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
HMO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicaid
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicare Part A
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicare Part B
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
POS
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
PPO
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52235
null
cpt
Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope
humana - medicare advantage
Workers Comp
O
17312.24
2724.53
2724.53
4856.39
10387.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
EPO
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
HMO
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
Medicaid
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
Medicare Part A
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
Medicare Part B
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
POS
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
PPO
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
aetna
Workers Comp
O
23018.21
3680.94
3681.23
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
EPO
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
HMO
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
Medicaid
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
Medicare Part A
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
Medicare Part B
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
POS
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
PPO
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
blue cross blue shield
Workers Comp
O
23018.21
3680.94
6418.51
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
EPO
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
HMO
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
Medicaid
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
Medicare Part A
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
Medicare Part B
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
POS
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
PPO
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52240
null
cpt
Destruction and/or removal of large growths of the bladder using an endoscope
humana - medicare advantage
Workers Comp
O
23018.21
3680.94
3680.94
6418.51
13810.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
EPO
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
HMO
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
Medicaid
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
Medicare Part A
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
Medicare Part B
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
POS
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
PPO
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
blue cross blue shield
Workers Comp
O
12783.30
1569.38
4681.97
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
EPO
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
HMO
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
Medicaid
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
Medicare Part A
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
Medicare Part B
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
POS
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
PPO
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52260
null
cpt
Dilation of the bladder using an endoscope under general or spinal anesthesia
tricare
Workers Comp
O
12783.30
1569.38
1569.38
4681.97
7669.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
EPO
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
HMO
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
Medicaid
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
Medicare Part A
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
Medicare Part B
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
POS
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
PPO
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52276
null
cpt
Incision of the bladder canal (urethra) using an endoscope
tricare
Workers Comp
O
14242.83
1578.66
1578.66
1578.66
8545.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
EPO
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
HMO
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
Medicaid
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
Medicare Part A
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
Medicare Part B
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
POS
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
PPO
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield
Workers Comp
O
13859.32
1569.38
3276.74
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
EPO
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
HMO
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
POS
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
PPO
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
13859.32
1569.38
3781.50
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
EPO
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
HMO
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicaid
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicare Part A
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
Medicare Part B
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
POS
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
PPO
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
humana - medicare advantage
Workers Comp
O
13859.32
1569.38
1569.38
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
EPO
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
HMO
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
Medicaid
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
Medicare Part A
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
Medicare Part B
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
POS
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
PPO
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52281
null
cpt
Dilation of bladder canal (urethra) using an endoscope
tricare
Workers Comp
O
13859.32
1569.38
1587.94
3781.50
8315.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
EPO
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
HMO
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
Medicaid
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
Medicare Part A
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
Medicare Part B
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
POS
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
PPO
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52310
null
cpt
Removal of foreign body stone or stent from bladder canal (urethra) or bladder using an endoscope
humana - medicare advantage
Workers Comp
O
26825.03
2724.53
2724.53
2724.53
16095.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
EPO
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
HMO
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
Medicaid
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
Medicare Part A
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
Medicare Part B
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
POS
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
PPO
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52317
null
cpt
Crushing fragmenting and removal of (less than 2.5 centimeters) bladder stone
aetna
Workers Comp
O
17606.31
7585.06
7585.06
7585.06
10563.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
EPO
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
HMO
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicaid
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicare Part A
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicare Part B
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
POS
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
PPO
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52320
null
cpt
Removal of stone in urinary duct (ureter) using an endoscope
humana - medicare advantage
Workers Comp
O
32270.44
2724.53
2724.53
2724.53
19362.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
EPO
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
HMO
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
Medicaid
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
Medicare Part A
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
Medicare Part B
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
POS
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
PPO
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield
Workers Comp
O
21239.84
2674.06
7182.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
EPO
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
HMO
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
POS
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
PPO
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
21239.84
2674.06
3976.61
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
EPO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
HMO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicaid
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicare Part A
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
Medicare Part B
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
POS
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
PPO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
humana - medicare advantage
Workers Comp
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
EPO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
HMO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
Medicaid
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
Medicare Part A
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
Medicare Part B
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
POS
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
PPO
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
tricare
Workers Comp
O
21239.84
2674.06
2674.06
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
EPO
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
HMO
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
Medicaid
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
Medicare Part A
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
Medicare Part B
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
POS
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
PPO
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52332
null
cpt
Insertion of stent in urinary duct (ureter) using an endoscope
va
Workers Comp
O
21239.84
2674.06
2724.44
7182.61
12743.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
EPO
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
HMO
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicaid
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicare Part A
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicare Part B
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
POS
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
PPO
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Workers Comp
O
16246.37
2674.06
6627.47
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
EPO
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
HMO
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
Medicaid
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
Medicare Part A
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
Medicare Part B
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
POS
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
PPO
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
tricare
Workers Comp
O
16246.37
2674.06
2674.06
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
EPO
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
HMO
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
Medicaid
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
Medicare Part A
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
Medicare Part B
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
POS
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
PPO
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52351
null
cpt
Diagnostic examination of the bladder bladder canal (urethra) and urinary duct (ureter) or kidney using an endoscope
va
Workers Comp
O
16246.37
2674.06
2724.44
6627.47
9747.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
EPO
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
HMO
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicaid
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicare Part A
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Medicare Part B
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
POS
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
PPO
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
blue cross blue shield
Workers Comp
O
20809.78
2674.06
7284.33
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
EPO
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
HMO
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
Medicaid
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
Medicare Part A
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
Medicare Part B
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
POS
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
PPO
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
humana - medicare advantage
Workers Comp
O
20809.78
2674.06
2724.53
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
EPO
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
HMO
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
Medicaid
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
Medicare Part A
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
Medicare Part B
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
POS
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
PPO
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
tricare
Workers Comp
O
20809.78
2674.06
2674.06
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
EPO
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
HMO
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
Medicaid
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
Medicare Part A
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
Medicare Part B
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
POS
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
PPO
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52352
null
cpt
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope
va
Workers Comp
O
20809.78
2674.06
2724.44
7284.33
12485.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
EPO
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
HMO
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
Medicaid
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
Medicare Part A
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
Medicare Part B
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
POS
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
PPO
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
blue cross blue shield
Workers Comp
O
23899.83
3714.18
8931.02
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
EPO
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
HMO
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
Medicaid
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
Medicare Part A
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
Medicare Part B
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
POS
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
PPO
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
humana - medicare advantage
Workers Comp
O
23899.83
3714.18
3714.18
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
EPO
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
HMO
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
Medicaid
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
Medicare Part A
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
Medicare Part B
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
POS
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
PPO
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
tricare
Workers Comp
O
23899.83
3714.18
3748.71
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
EPO
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
HMO
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
Medicaid
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
Medicare Part A
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
Medicare Part B
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
POS
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
PPO
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52356
null
cpt
Crushing of stone in urinary duct (ureter) with stent using an endoscope
va
Workers Comp
O
23899.83
3714.18
3908.99
8931.02
14339.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
EPO
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
HMO
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
Medicaid
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
Medicare Part A
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
Medicare Part B
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
POS
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
PPO
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
aetna - medicare advantage
Workers Comp
O
23774.84
3748.71
3928.44
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
EPO
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
HMO
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
Medicaid
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
Medicare Part A
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
Medicare Part B
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
POS
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
PPO
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
blue cross blue shield
Workers Comp
O
23774.84
3748.71
7860.57
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
EPO
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
HMO
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
Medicaid
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
Medicare Part A
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
Medicare Part B
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
POS
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
PPO
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
humana - medicare advantage
Workers Comp
O
23774.84
3748.71
3909.13
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
EPO
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
HMO
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
Medicaid
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
Medicare Part A
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
Medicare Part B
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
POS
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
PPO
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
52601
null
cpt
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope
tricare
Workers Comp
O
23774.84
3748.71
3748.71
7860.57
14264.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
EPO
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
HMO
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
Medicaid
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
Medicare Part A
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
Medicare Part B
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
POS
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
PPO
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53020
null
cpt
Incision of external urinary opening
va
Workers Comp
O
9754.52
3655.12
3655.12
3655.12
5852.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
EPO
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
HMO
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
Medicaid
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
Medicare Part A
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
Medicare Part B
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
POS
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
PPO
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53270
null
cpt
Removal or destruction of bladder canal (urethra) mucous glands
tricare
Workers Comp
O
19747.43
2724.53
2724.53
2724.53
11848.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
EPO
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
HMO
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
Medicaid
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
Medicare Part A
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
Medicare Part B
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
POS
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
PPO
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
blue cross blue shield
Workers Comp
O
27250.15
235.70
13341.89
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
EPO
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
HMO
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
Medicaid
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
Medicare Part A
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
Medicare Part B
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
POS
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
PPO
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
humana - medicare advantage
Workers Comp
O
27250.15
235.70
2146.96
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
EPO
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
HMO
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
Medicaid
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
Medicare Part A
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
Medicare Part B
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
POS
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
PPO
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
53899
null
cpt
Urinary system procedure
tricare
Workers Comp
O
27250.15
235.70
235.70
13341.89
16350.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
EPO
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
HMO
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
Medicaid
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
Medicare Part A
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
Medicare Part B
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
POS
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
PPO
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
540
null
ms-drg
osteomyelitis with cc
humana - medicare advantage
Workers Comp
I
17512.52
8048.22
8048.22
8048.22
10507.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
EPO
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
HMO
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
Medicaid
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
Medicare Part A
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
Medicare Part B
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
POS
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
PPO
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54001
null
cpt
Incision of penile foreskin
blue cross blue shield - medicare advantage
Workers Comp
O
16114.58
4580.48
4580.48
4580.48
9668.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
EPO
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
HMO
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
Medicaid
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
Medicare Part A
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
Medicare Part B
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
POS
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
PPO
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
blue cross blue shield
Workers Comp
O
16646.47
1292.94
8428.23
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
EPO
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
HMO
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
Medicaid
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
Medicare Part A
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
Medicare Part B
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
POS
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
PPO
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
humana - medicare advantage
Workers Comp
O
16646.47
1292.94
1292.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
EPO
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
HMO
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
Medicaid
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
Medicare Part A
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
Medicare Part B
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
POS
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
PPO
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54150
null
cpt
Removal of foreskin of using clamp or device
tricare
Workers Comp
O
16646.47
1292.94
1587.94
8428.23
9987.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
EPO
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
HMO
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
Medicaid
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
Medicare Part A
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
Medicare Part B
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
POS
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
PPO
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
tricare
Workers Comp
O
14831.61
1563.11
1569.38
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
EPO
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
HMO
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
Medicaid
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
Medicare Part A
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
Medicare Part B
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
POS
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
PPO
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54161
null
cpt
Removal of foreskin patient older than 28 days of age
va
Workers Comp
O
14831.61
1563.11
1563.11
1569.38
8898.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
EPO
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
HMO
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
Medicaid
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
Medicare Part A
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
Medicare Part B
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
POS
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
PPO
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54163
null
cpt
Repair of incomplete removal of penile foreskin
humana - medicare advantage
Workers Comp
O
14244.89
3909.13
3909.13
3909.13
8546.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
EPO
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
HMO
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
Medicaid
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
Medicare Part A
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
Medicare Part B
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
POS
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
PPO
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
543
null
ms-drg
pathological fractures and musculoskeletal and connective tissue malignancy with cc
blue cross blue shield
Workers Comp
I
31850.27
12147.75
12147.75
12147.75
19110.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
EPO
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
HMO
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
Medicaid
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
Medicare Part A
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
Medicare Part B
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
POS
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
PPO
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54405
null
cpt
Insertion of multi-component inflatable penile prosthesis
humana - medicare advantage
Workers Comp
O
88496.36
16170.33
16170.33
16170.33
53097.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
EPO
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
HMO
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
Medicaid
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
Medicare Part A
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
Medicare Part B
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
POS
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
PPO
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
tricare
Workers Comp
O
17550.93
2674.06
2674.06
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
EPO
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
HMO
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
Medicaid
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
Medicare Part A
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
Medicare Part B
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
POS
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
PPO
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54520
null
cpt
Removal of testicle
va
Workers Comp
O
17550.93
2674.06
2724.44
2724.44
10530.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
EPO
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
HMO
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
Medicaid
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
Medicare Part A
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
Medicare Part B
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
POS
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
PPO
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54530
null
cpt
Removal of one testis (testicle) for tumor groin approach
tricare
Workers Comp
O
19816.83
2541.65
2541.65
2541.65
11890.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
EPO
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
HMO
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
Medicaid
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
Medicare Part A
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
Medicare Part B
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
POS
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
PPO
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54600
null
cpt
Repair of twisted testicle
tricare
Workers Comp
O
15800.12
2754.50
2754.50
2754.50
9480.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
EPO
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
HMO
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
Medicaid
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
Medicare Part A
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
Medicare Part B
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
POS
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
PPO
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54640
null
cpt
Repositioning and fixation of misplaced testicle
tricare
Workers Comp
O
16675.53
2786.93
2786.93
2786.93
10005.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
EPO
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
HMO
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
Medicaid
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
Medicare Part A
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
Medicare Part B
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
POS
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
PPO
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
blue cross blue shield
Workers Comp
O
17180.72
1587.94
6361.80
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
EPO
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
HMO
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
Medicaid
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
Medicare Part A
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
Medicare Part B
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
POS
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
PPO
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
54840
null
cpt
Removal of fluid accumulation in sperm reservoir
tricare
Workers Comp
O
17180.72
1587.94
1587.94
6361.80
10308.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
EPO
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
HMO
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
Medicaid
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
Medicare Part A
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
Medicare Part B
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
POS
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
PPO
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
549
null
ms-drg
septic arthritis with cc
blue cross blue shield
Workers Comp
I
22644.26
11423.96
11423.96
11423.96
13586.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
EPO
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
HMO
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
Medicaid
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
Medicare Part A
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
Medicare Part B
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
POS
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
PPO
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
blue cross blue shield
Workers Comp
O
17905.57
2786.93
5453.87
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
EPO
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
HMO
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
Medicaid
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
Medicare Part A
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
Medicare Part B
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
POS
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
PPO
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
tricare
Workers Comp
O
17905.57
2786.93
2786.93
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
EPO
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
HMO
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
Medicaid
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
Medicare Part A
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
Medicare Part B
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
POS
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
PPO
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55040
null
cpt
Removal of fluid accumulation in one testicle and sperm reservoir
va
Workers Comp
O
17905.57
2786.93
2819.26
5453.87
10743.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
EPO
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
HMO
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
Medicaid
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
Medicare Part A
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
Medicare Part B
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
POS
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
PPO
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
blue cross blue shield
Workers Comp
I
34869.99
9058.66
17368.71
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
EPO
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
HMO
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
Medicaid
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
Medicare Part A
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
Medicare Part B
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
POS
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
PPO
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
551
null
ms-drg
medical back problems with mcc
humana - medicare advantage
Workers Comp
I
34869.99
9058.66
9058.66
17368.71
20921.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
EPO
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
HMO
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
Medicaid
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
Medicare Part A
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
Medicare Part B
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
POS
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
PPO
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield
Workers Comp
I
21234.00
3732.31
8547.41
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
EPO
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
HMO
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
Medicaid
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
POS
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
PPO
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
21234.00
3732.31
6348.02
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
EPO
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
HMO
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
Medicaid
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
Medicare Part A
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
Medicare Part B
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
POS
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
PPO
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
humana - medicare advantage
Workers Comp
I
21234.00
3732.31
4535.29
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
EPO
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
HMO
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
Medicaid
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
Medicare Part A
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
Medicare Part B
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
POS
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
PPO
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
tricare
Workers Comp
I
21234.00
3732.31
3732.31
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
EPO
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
HMO
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
Medicaid
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
Medicare Part A
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
Medicare Part B
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
POS
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
PPO
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
552
null
ms-drg
medical back problems without mcc
webtpa
Workers Comp
I
21234.00
3732.31
16597.13
16597.13
12740.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
EPO
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
HMO
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
Medicaid
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
Medicare Part A
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
Medicare Part B
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
POS
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
PPO
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
aetna
Workers Comp
O
14399.96
1569.38
8468.46
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
EPO
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
HMO
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
Medicaid
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
Medicare Part A
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
Medicare Part B
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
POS
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
PPO
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55250
null
cpt
Removal of sperm duct
tricare
Workers Comp
O
14399.96
1569.38
1569.38
8468.46
8639.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
EPO
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
HMO
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
Medicaid
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
Medicare Part A
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
Medicare Part B
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
POS
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
PPO
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
553
null
ms-drg
bone diseases and arthropathies with mcc
blue cross blue shield
Workers Comp
I
32473.32
12327.66
12327.66
12327.66
19483.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
EPO
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
HMO
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
Medicaid
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
Medicare Part A
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
Medicare Part B
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
POS
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
PPO
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield
Workers Comp
I
19833.06
5427.28
8455.50
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
EPO
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
HMO
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
Medicaid
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
POS
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
PPO
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
19833.06
5427.28
6172.89
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
EPO
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
HMO
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
Medicaid
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
Medicare Part A
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
Medicare Part B
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
POS
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
PPO
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
554
null
ms-drg
bone diseases and arthropathies without mcc
humana - medicare advantage
Workers Comp
I
19833.06
5427.28
5427.28
8455.50
11899.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
EPO
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
HMO
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
Medicaid
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
Medicare Part A
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
Medicare Part B
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
POS
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
PPO
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55400
null
cpt
Incision or repair of sperm duct
tricare
Workers Comp
O
29910.36
2674.06
2674.06
2674.06
17946.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
EPO
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
HMO
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
Medicaid
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
Medicare Part A
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
Medicare Part B
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
POS
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
PPO
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield
Workers Comp
O
21168.24
2661.53
7625.67
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
EPO
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
HMO
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
Medicaid
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
Medicare Part A
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
Medicare Part B
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
POS
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
PPO
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
blue cross blue shield - medicare advantage
Workers Comp
O
21168.24
2661.53
8920.51
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
EPO
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
HMO
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
Medicaid
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
Medicare Part A
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
Medicare Part B
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
POS
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
PPO
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55520
null
cpt
Removal of spermatic cord growth
tricare
Workers Comp
O
21168.24
2661.53
2661.53
8920.51
12700.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
EPO
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
HMO
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
Medicaid
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
Medicare Part A
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
Medicare Part B
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
POS
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
PPO
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
blue cross blue shield
Workers Comp
O
19023.21
2674.06
4934.97
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
EPO
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
HMO
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
Medicaid
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
Medicare Part A
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
Medicare Part B
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
POS
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
PPO
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
tricare
Workers Comp
O
19023.21
2674.06
2674.06
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
EPO
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
HMO
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
Medicaid
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
Medicare Part A
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
Medicare Part B
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
POS
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
PPO
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55530
null
cpt
Removal of spermatic cord venous dilation or tying of spermatic veins
va
Workers Comp
O
19023.21
2674.06
2724.44
4934.97
11413.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
EPO
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
HMO
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
Medicaid
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
Medicare Part A
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
Medicare Part B
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
POS
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
PPO
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
blue cross blue shield
Workers Comp
O
27447.58
4367.56
7590.87
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
EPO
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
HMO
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
Medicaid
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
Medicare Part A
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
Medicare Part B
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
POS
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
PPO
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
tricare
Workers Comp
O
27447.58
4367.56
4381.91
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
EPO
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
HMO
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
Medicaid
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
Medicare Part A
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
Medicare Part B
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
POS
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
PPO
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55559
null
cpt
Spermatic cord procedure using an endoscope
va
Workers Comp
O
27447.58
4367.56
4367.56
7590.87
16468.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
EPO
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
HMO
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
Medicaid
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
Medicare Part A
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
Medicare Part B
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
POS
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
PPO
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
blue cross blue shield
Workers Comp
I
20711.41
7435.29
12148.86
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
EPO
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
HMO
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
Medicaid
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
Medicare Part A
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
Medicare Part B
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
POS
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
PPO
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
557
null
ms-drg
tendonitis myositis and bursitis with mcc
tricare
Workers Comp
I
20711.41
7435.29
7435.29
12148.86
12426.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
EPO
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
HMO
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
Medicaid
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
Medicare Part A
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
Medicare Part B
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
POS
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
PPO
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
blue cross blue shield
Workers Comp
O
14455.52
1587.89
3923.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
EPO
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
HMO
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
Medicaid
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
Medicare Part A
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
Medicare Part B
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
POS
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
PPO
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
tricare
Workers Comp
O
14455.52
1587.89
2046.70
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
EPO
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
HMO
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
Medicaid
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
Medicare Part A
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
Medicare Part B
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
POS
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
PPO
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
united healthcare
Workers Comp
O
14455.52
1587.89
7803.63
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
EPO
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
HMO
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
Medicaid
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
Medicare Part A
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
Medicare Part B
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
POS
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
PPO
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55700
null
cpt
Prostate Biopsy
va
Workers Comp
O
14455.52
1587.89
1587.89
7803.63
1883.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
EPO
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
HMO
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
Medicaid
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
Medicare Part A
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
Medicare Part B
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
POS
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
PPO
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
tricare
Workers Comp
I
12817.03
3373.57
3373.57
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
EPO
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
HMO
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
Medicaid
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
Medicare Part A
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
Medicare Part B
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
POS
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
PPO
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
558
null
ms-drg
tendonitis myositis and bursitis without mcc
va
Workers Comp
I
12817.03
3373.57
6166.35
6166.35
7690.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
EPO
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
HMO
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
Medicaid
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
Medicare Part A
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
Medicare Part B
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
POS
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
PPO
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55874
null
cpt
Injection of biodegradable material next to prostate
humana - medicare advantage
Workers Comp
O
21083.40
3909.13
3909.13
3909.13
12650.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
EPO
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
HMO
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
Medicaid
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
Medicare Part A
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
Medicare Part B
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
POS
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
PPO
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
55876
null
cpt
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance
humana - medicare advantage
Workers Comp
O
25414.47
1103.22
1103.22
1103.22
15248.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
EPO
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
HMO
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
Medicaid
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
Medicare Part A
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
Medicare Part B
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
POS
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
PPO
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
559
null
ms-drg
aftercare musculoskeletal system and connective tissue with mcc
blue cross blue shield
Workers Comp
I
51720.95
16078.27
16078.27
16078.27
31032.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
EPO
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
HMO
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
Medicaid
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
Medicare Part A
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
Medicare Part B
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
POS
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
PPO
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
blue cross blue shield
Workers Comp
I
37529.37
10603.69
10603.69
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
EPO
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
HMO
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
Medicaid
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
Medicare Part A
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
Medicare Part B
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
POS
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
PPO
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
560
null
ms-drg
aftercare musculoskeletal system and connective tissue with cc
tricare
Workers Comp
I
37529.37
10603.69
15407.18
15407.18
22517.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
EPO
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
HMO
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
Medicaid
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
Medicare Part A
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
Medicare Part B
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
POS
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
PPO
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
blue cross blue shield
Workers Comp
I
30131.33
6778.40
6778.40
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
EPO
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
HMO
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
Medicaid
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
Medicare Part A
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
Medicare Part B
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
POS
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
PPO
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
561
null
ms-drg
aftercare musculoskeletal system and connective tissue without cc/mcc
tricare
Workers Comp
I
30131.33
6778.40
12323.23
12323.23
18078.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
EPO
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
HMO
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
Medicaid
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
Medicare Part A
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
Medicare Part B
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
POS
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
PPO
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
563
null
ms-drg
fracture sprain strain and dislocation except femur hip pelvis and thigh without mcc
humana - medicare advantage
Workers Comp
I
19306.71
4606.09
4606.09
4606.09
11584.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
EPO
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
HMO
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
Medicaid
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
Medicare Part A
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
Medicare Part B
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
POS
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
PPO
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
564
null
ms-drg
other musculoskeletal system and connective tissue diagnoses with mcc
humana - medicare advantage
Workers Comp
I
49477.32
7845.38
7845.38
7845.38
29686.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
EPO
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
HMO
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
Medicaid
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
Medicare Part A
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
Medicare Part B
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
POS
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
PPO
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56440
null
cpt
Creation of drainage tract for female genital gland or cyst
tricare
Workers Comp
O
2457.12
2323.22
2323.22
2323.22
1474.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
EPO
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
HMO
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
Medicaid
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
Medicare Part A
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
Medicare Part B
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
POS
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
PPO
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56501
null
cpt
Destruction of external female genital growths
blue cross blue shield
Workers Comp
O
17333.87
4609.59
4609.59
4609.59
10400.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
EPO
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
HMO
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
Medicaid
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
Medicare Part A
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
Medicare Part B
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
POS
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
PPO
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
56620
null
cpt
Partial removal of external female genitals simple
tricare
Workers Comp
O
18880.24
2323.22
2323.22
2323.22
11328.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
EPO
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
HMO
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
Medicaid
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
Medicare Part A
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
Medicare Part B
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
POS
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
PPO
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
humana - medicare advantage
Workers Comp
I
48200.41
9983.09
9983.09
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
EPO
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
HMO
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
Medicaid
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
Medicare Part A
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
Medicare Part B
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
POS
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
PPO
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
571
null
ms-drg
skin debridement with cc
va
Workers Comp
I
48200.41
9983.09
10958.38
10958.38
28920.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
EPO
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
HMO
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
Medicaid
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
Medicare Part A
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
Medicare Part B
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
POS
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
PPO
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57120
null
cpt
Suture closure of the vagina and vaginal opening
humana - medicare advantage
Workers Comp
O
35556.40
3905.27
3905.27
3905.27
21333.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
EPO
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
HMO
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
Medicaid
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
Medicare Part A
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
Medicare Part B
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
POS
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
PPO
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57240
null
cpt
Repair of herniation of bladder into vaginal wall
blue cross blue shield
Workers Comp
O
26358.05
8570.61
8570.61
8570.61
15814.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
EPO
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
HMO
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
Medicaid
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
Medicare Part A
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
Medicare Part B
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
POS
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
PPO
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
blue cross blue shield
Workers Comp
O
45233.06
7453.01
11552.92
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
EPO
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
HMO
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
Medicaid
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
Medicare Part A
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
Medicare Part B
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
POS
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
PPO
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57260
null
cpt
Plastic repair of vagina and tissue separating vagina rectum and bladder
tricare
Workers Comp
O
45233.06
7453.01
7453.01
11552.92
27139.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
EPO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
HMO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
Medicaid
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
Medicare Part A
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
Medicare Part B
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
POS
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
PPO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57283
null
cpt
Anatomic repositioning of vagina
blue cross blue shield - medicare advantage
Workers Comp
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
EPO
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
HMO
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
Medicaid
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
Medicare Part A
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
Medicare Part B
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
POS
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
PPO
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57287
null
cpt
Removal or revision of sling around bladder canal (urethra) to control leakage
va
Workers Comp
O
17313.64
9487.08
9487.08
9487.08
10388.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
EPO
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
HMO
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
Medicaid
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
Medicare Part A
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
Medicare Part B
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
POS
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
PPO
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
aetna
Workers Comp
O
25958.01
3810.43
9490.45
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
EPO
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
HMO
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
Medicaid
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
Medicare Part A
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
Medicare Part B
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
POS
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
PPO
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield
Workers Comp
O
25958.01
3810.43
12903.88
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
EPO
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
HMO
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
Medicaid
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
Medicare Part A
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
Medicare Part B
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
POS
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
PPO
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
blue cross blue shield - medicare advantage
Workers Comp
O
25958.01
3810.43
7480.94
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
EPO
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
HMO
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
Medicaid
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
Medicare Part A
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
Medicare Part B
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
POS
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
PPO
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
humana - medicare advantage
Workers Comp
O
25958.01
3810.43
3810.43
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
EPO
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
HMO
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
Medicaid
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
Medicare Part A
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
Medicare Part B
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
POS
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
PPO
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57288
null
cpt
Creation of sling around bladder canal (urethra) to control leakage
tricare
Workers Comp
O
25958.01
3810.43
3905.27
12903.88
15574.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
EPO
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
HMO
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
Medicaid
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
Medicare Part A
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
Medicare Part B
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
POS
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
PPO
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
blue cross blue shield
Workers Comp
O
41310.53
7453.01
11055.93
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
EPO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
HMO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
Medicaid
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
Medicare Part A
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
Medicare Part B
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
POS
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
PPO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
humana - medicare advantage
Workers Comp
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
EPO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
HMO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
Medicaid
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
Medicare Part A
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
Medicare Part B
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
POS
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
PPO
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57425
null
cpt
Surgical vaginal defect repair using an endoscope
tricare
Workers Comp
O
41310.53
7453.01
7453.01
11055.93
24786.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
EPO
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
HMO
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
Medicaid
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
Medicare Part A
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
Medicare Part B
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
POS
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
PPO
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield
Workers Comp
O
14688.09
966.20
2483.49
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
EPO
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
HMO
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
Medicaid
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
Medicare Part A
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
Medicare Part B
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
POS
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
PPO
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57460
null
cpt
Biopsy of cervix using an endoscope with a loop electrode
blue cross blue shield - medicare advantage
Workers Comp
O
14688.09
966.20
966.20
2483.49
8812.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
EPO
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
HMO
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
Medicaid
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
Medicare Part A
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
Medicare Part B
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
POS
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
PPO
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57505
null
cpt
Scraping of tissue of cervix
blue cross blue shield - medicare advantage
Workers Comp
O
8744.43
966.20
966.20
966.20
5246.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
EPO
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
HMO
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
Medicaid
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
Medicare Part A
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
Medicare Part B
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
POS
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
PPO
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57520
null
cpt
Removal or destruction of cervix with knife or laser
tricare
Workers Comp
O
18428.84
2323.22
2323.22
2323.22
11057.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
EPO
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
HMO
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
Medicaid
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
Medicare Part A
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
Medicare Part B
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
POS
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
PPO
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
aetna
Workers Comp
O
16485.57
2268.12
8729.28
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
EPO
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
HMO
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
Medicaid
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
Medicare Part A
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
Medicare Part B
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
POS
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
PPO
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield
Workers Comp
O
16485.57
2268.12
4189.48
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
EPO
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
HMO
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
Medicaid
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
Medicare Part A
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
Medicare Part B
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
POS
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
PPO
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
blue cross blue shield - medicare advantage
Workers Comp
O
16485.57
2268.12
3868.22
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
EPO
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
HMO
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
Medicaid
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
Medicare Part A
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
Medicare Part B
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
POS
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
PPO
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
57522
null
cpt
Removal or destruction of cervix with electrical cautery
tricare
Workers Comp
O
16485.57
2268.12
2268.12
8729.28
9891.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
EPO
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
HMO
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
Medicaid
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
Medicare Part A
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
Medicare Part B
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
POS
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
PPO
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
aetna - medicare advantage
Workers Comp
I
58548.27
8353.30
8353.30
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
EPO
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
HMO
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
Medicaid
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
Medicare Part A
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
Medicare Part B
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
POS
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
PPO
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield
Workers Comp
I
58548.27
8353.30
15249.95
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
EPO
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
HMO
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
POS
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
PPO
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
58548.27
8353.30
11839.42
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
EPO
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
HMO
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
Medicaid
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
Medicare Part A
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
Medicare Part B
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
POS
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
PPO
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
humana - medicare advantage
Workers Comp
I
58548.27
8353.30
10222.92
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
EPO
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
HMO
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
Medicaid
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
Medicare Part A
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
Medicare Part B
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
POS
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
PPO
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
580
null
ms-drg
other skin subcutaneous tissue and breast procedures with cc
va
Workers Comp
I
58548.27
8353.30
11627.87
15249.95
35128.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
EPO
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
HMO
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
Medicaid
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
POS
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
PPO
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
581
null
ms-drg
other skin subcutaneous tissue and breast procedures without cc/mcc
blue cross blue shield
Workers Comp
I
33585.44
10052.71
10052.71
10052.71
20151.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
EPO
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
HMO
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
Medicaid
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
Medicare Part A
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
Medicare Part B
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
POS
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
PPO
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58301
null
cpt
Removal of intra-uterine device (IUD) for pregnancy prevention
tricare
Workers Comp
O
16076.30
4282.09
4282.09
4282.09
9645.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
EPO
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
HMO
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
Medicaid
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
Medicare Part A
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
Medicare Part B
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
POS
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
PPO
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
aetna
Workers Comp
O
21492.99
2323.22
10921.79
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
EPO
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
HMO
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
Medicaid
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
Medicare Part A
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
Medicare Part B
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
POS
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
PPO
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield
Workers Comp
O
21492.99
2323.22
7938.65
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
EPO
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
HMO
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
POS
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
PPO
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
21492.99
2323.22
7717.38
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
EPO
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
HMO
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
Medicaid
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
Medicare Part A
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
Medicare Part B
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
POS
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
PPO
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
humana - medicare advantage
Workers Comp
O
21492.99
2323.22
3905.27
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
EPO
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
HMO
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
Medicaid
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
Medicare Part A
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
Medicare Part B
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
POS
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
PPO
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58558
null
cpt
Biopsy and/or removal of polyp of the uterus using an endoscope
tricare
Workers Comp
O
21492.99
2323.22
2323.22
10921.79
12895.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
EPO
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
HMO
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
Medicaid
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
Medicare Part A
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
Medicare Part B
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
POS
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
PPO
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield
Workers Comp
O
24463.32
3905.27
6142.86
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
EPO
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
HMO
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
POS
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
PPO
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
24463.32
3905.27
10065.80
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
EPO
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
HMO
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
Medicaid
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
Medicare Part A
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
Medicare Part B
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
POS
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
PPO
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58563
null
cpt
Examination of uterus with destruction of uterine lining using an endoscope
tricare
Workers Comp
O
24463.32
3905.27
3905.27
10065.80
14677.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
EPO
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
HMO
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
Medicaid
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
Medicare Part A
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
Medicare Part B
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
POS
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
PPO
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield
Workers Comp
O
30915.00
7453.01
10100.21
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
EPO
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
HMO
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
POS
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
PPO
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
30915.00
7453.01
8555.15
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
EPO
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
HMO
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
Medicaid
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
Medicare Part A
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
Medicare Part B
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
POS
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
PPO
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
cigna
Workers Comp
O
30915.00
7453.01
19270.59
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
EPO
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
HMO
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
Medicaid
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
Medicare Part A
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
Medicare Part B
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
POS
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
PPO
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
humana - medicare advantage
Workers Comp
O
30915.00
7453.01
7453.01
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
EPO
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
HMO
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
Medicaid
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
Medicare Part A
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
Medicare Part B
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
POS
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
PPO
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
tricare
Workers Comp
O
30915.00
7453.01
7888.98
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
EPO
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
HMO
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
Medicaid
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
Medicare Part A
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
Medicare Part B
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
POS
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
PPO
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58571
null
cpt
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope
va
Workers Comp
O
30915.00
7453.01
7888.71
19270.59
18549.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
EPO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
HMO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
POS
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
PPO
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58572
null
cpt
Abdominal removal of uterus (greater than 250 grams) using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
34755.44
14259.40
14259.40
14259.40
20853.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
EPO
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
HMO
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
Medicaid
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
Medicare Part A
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
Medicare Part B
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
POS
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
PPO
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
blue cross blue shield
Workers Comp
O
34471.14
7788.37
13192.14
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
EPO
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
HMO
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
Medicaid
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
Medicare Part A
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
Medicare Part B
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
POS
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
PPO
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58573
null
cpt
Abdominal removal of uterus (greater than 250 grams) tubes and/or ovaries using an endoscope
va
Workers Comp
O
34471.14
7788.37
7788.37
13192.14
20682.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
EPO
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
HMO
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
Medicaid
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
Medicare Part A
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
Medicare Part B
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
POS
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
PPO
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58579
null
cpt
Unlisted hysteroscopy of uterus procedure
blue cross blue shield
Workers Comp
O
27128.52
9903.31
9903.31
9903.31
16277.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
EPO
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
HMO
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
Medicaid
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
Medicare Part A
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
Medicare Part B
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
POS
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
PPO
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield
Workers Comp
O
20686.03
2057.87
10512.00
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
EPO
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
HMO
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
POS
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
PPO
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
20686.03
2057.87
7669.79
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
EPO
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
HMO
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
Medicaid
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
Medicare Part A
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
Medicare Part B
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
POS
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
PPO
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
healthchoice
Workers Comp
O
20686.03
2057.87
2057.87
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
EPO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
HMO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
Medicaid
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
Medicare Part A
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
Medicare Part B
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
POS
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
PPO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
humana - medicare advantage
Workers Comp
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
EPO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
HMO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
Medicaid
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
Medicare Part A
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
Medicare Part B
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
POS
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
PPO
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
tricare
Workers Comp
O
20686.03
2057.87
4282.09
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
EPO
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
HMO
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
Medicaid
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
Medicare Part A
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
Medicare Part B
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
POS
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
PPO
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58661
null
cpt
Removal of ovaries and/or tubes using an endoscope
united healthcare
Workers Comp
O
20686.03
2057.87
15489.80
15489.80
12411.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
EPO
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
HMO
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
Medicaid
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
Medicare Part A
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
Medicare Part B
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
POS
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
PPO
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield
Workers Comp
O
17517.16
4381.91
10162.05
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
EPO
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
HMO
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
Medicaid
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
Medicare Part A
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
Medicare Part B
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
POS
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
PPO
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
blue cross blue shield - medicare advantage
Workers Comp
O
17517.16
4381.91
8500.34
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
EPO
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
HMO
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
Medicaid
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
Medicare Part A
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
Medicare Part B
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
POS
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
PPO
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
tricare
Workers Comp
O
17517.16
4381.91
4381.91
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
EPO
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
HMO
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
Medicaid
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
Medicare Part A
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
Medicare Part B
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
POS
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
PPO
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58662
null
cpt
Destruction or removal of ovary or pelvic growths using an endoscope
united healthcare
Workers Comp
O
17517.16
4381.91
13137.87
13137.87
10510.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
EPO
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
HMO
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
Medicaid
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
Medicare Part A
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
Medicare Part B
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
POS
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
PPO
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
blue cross blue shield
Workers Comp
O
20170.18
4481.73
9081.12
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
EPO
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
HMO
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
Medicaid
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
Medicare Part A
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
Medicare Part B
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
POS
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
PPO
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
58670
null
cpt
Destruction of ovaries using an endoscope
tricare
Workers Comp
O
20170.18
4481.73
4481.73
9081.12
12102.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
EPO
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
HMO
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
Medicaid
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
Medicare Part A
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
Medicare Part B
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
POS
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
PPO
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
aetna
Workers Comp
O
235.95
8.88
142.56
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
EPO
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
HMO
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
Medicaid
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
Medicare Part A
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
Medicare Part B
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
POS
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
PPO
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield
Workers Comp
O
235.95
8.88
99.37
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
EPO
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
HMO
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
Medicaid
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
Medicare Part A
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
Medicare Part B
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
POS
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
PPO
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
blue cross blue shield - medicare advantage
Workers Comp
O
235.95
8.88
88.00
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
EPO
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
HMO
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
Medicaid
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
Medicare Part A
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
Medicare Part B
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
POS
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
PPO
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
cigna
Workers Comp
O
235.95
8.88
166.97
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
EPO
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
HMO
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
Medicaid
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
Medicare Part A
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
Medicare Part B
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
POS
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
PPO
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
healthchoice
Workers Comp
O
235.95
8.88
12.51
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
EPO
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
HMO
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
Medicaid
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
Medicare Part A
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
Medicare Part B
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
POS
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
PPO
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
humana - medicare advantage
Workers Comp
O
235.95
8.88
147.10
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
EPO
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
HMO
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
Medicaid
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
Medicare Part A
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
Medicare Part B
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
POS
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
PPO
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
tricare
Workers Comp
O
235.95
8.88
8.88
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
EPO
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
HMO
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
Medicaid
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
Medicare Part A
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
Medicare Part B
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
POS
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
PPO
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
united healthcare
Workers Comp
O
235.95
8.88
168.54
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
EPO
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
HMO
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
Medicaid
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
Medicare Part A
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
Medicare Part B
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
POS
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
PPO
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59025
null
cpt
Fetal non-stress test
va
Workers Comp
O
235.95
8.88
188.55
188.55
141.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
EPO
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
HMO
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
Medicaid
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
Medicare Part A
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
Medicare Part B
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
POS
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
PPO
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
blue cross blue shield
Workers Comp
O
26882.84
3963.28
8684.23
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
EPO
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
HMO
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
Medicaid
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
Medicare Part A
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
Medicare Part B
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
POS
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
PPO
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59151
null
cpt
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope
tricare
Workers Comp
O
26882.84
3963.28
3963.28
8684.23
16129.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
EPO
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
HMO
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
Medicaid
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
Medicare Part A
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
Medicare Part B
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
POS
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
PPO
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59160
null
cpt
Scraping of lining of uterus post-delivery
tricare
Workers Comp
O
21367.33
2213.02
2213.02
2213.02
12820.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
EPO
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
HMO
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
Medicaid
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
Medicare Part A
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
Medicare Part B
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
POS
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
PPO
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
aetna - medicare advantage
Workers Comp
I
22935.77
7381.77
7625.28
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
EPO
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
HMO
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
Medicaid
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
Medicare Part A
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
Medicare Part B
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
POS
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
PPO
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
593
null
ms-drg
skin ulcers with cc
va
Workers Comp
I
22935.77
7381.77
7381.77
7625.28
13761.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
EPO
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
HMO
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
Medicaid
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
Medicare Part A
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
Medicare Part B
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
POS
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
PPO
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
596
null
ms-drg
major skin disorders without mcc
aetna
Workers Comp
I
42911.89
4749.34
4749.34
4749.34
25747.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
EPO
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
HMO
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
Medicaid
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
Medicare Part A
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
Medicare Part B
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
POS
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
PPO
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
blue cross blue shield
Workers Comp
O
20068.68
4694.81
4694.81
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
EPO
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
HMO
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
Medicaid
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
Medicare Part A
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
Medicare Part B
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
POS
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
PPO
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59812
null
cpt
Treatment of incomplete abortion
united healthcare
Workers Comp
O
20068.68
4694.81
15051.51
15051.51
12041.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
EPO
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
HMO
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
Medicaid
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
Medicare Part A
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
Medicare Part B
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
POS
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
PPO
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
blue cross blue shield - medicare advantage
Workers Comp
O
17420.69
2323.22
2524.17
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
EPO
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
HMO
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
Medicaid
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
Medicare Part A
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
Medicare Part B
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
POS
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
PPO
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
59820
null
cpt
Treatment of first trimester missed abortion
tricare
Workers Comp
O
17420.69
2323.22
2323.22
2524.17
10452.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
EPO
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
HMO
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
Medicaid
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
Medicare Part A
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
Medicare Part B
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
POS
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
PPO
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
humana - medicare advantage
Workers Comp
I
35383.82
5935.19
8556.44
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
EPO
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
HMO
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
Medicaid
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
Medicare Part A
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
Medicare Part B
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
POS
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
PPO
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
602
null
ms-drg
cellulitis with mcc
tricare
Workers Comp
I
35383.82
5935.19
5935.19
8556.44
21230.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
EPO
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
HMO
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
Medicaid
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
Medicare Part A
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
Medicare Part B
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
POS
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
PPO
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
blue cross blue shield
Workers Comp
O
25857.44
4282.09
12882.70
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
EPO
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
HMO
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
Medicaid
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
Medicare Part A
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
Medicare Part B
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
POS
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
PPO
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
geha
Workers Comp
O
25857.44
4282.09
14061.77
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
EPO
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
HMO
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
Medicaid
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
Medicare Part A
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
Medicare Part B
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
POS
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
PPO
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
humana - medicare advantage
Workers Comp
O
25857.44
4282.09
4282.09
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
EPO
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
HMO
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
Medicaid
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
Medicare Part A
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
Medicare Part B
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
POS
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
PPO
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60220
null
cpt
Total removal of thyroid lobe on one side of the neck
tricare
Workers Comp
O
25857.44
4282.09
4381.91
14061.77
15514.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
EPO
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
HMO
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
Medicaid
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
Medicare Part A
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
Medicare Part B
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
POS
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
PPO
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60240
null
cpt
Removal of thyroid complete
blue cross blue shield - medicare advantage
Workers Comp
O
26485.52
9169.26
9169.26
9169.26
15891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
EPO
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
HMO
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
Medicaid
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
Medicare Part A
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
Medicare Part B
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
POS
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
PPO
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
aetna
Workers Comp
I
18325.66
3037.73
7737.17
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
EPO
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
HMO
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
Medicaid
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
Medicare Part A
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
Medicare Part B
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
POS
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
PPO
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield
Workers Comp
I
18325.66
3037.73
7559.03
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
EPO
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
HMO
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
Medicaid
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
POS
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
PPO
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
18325.66
3037.73
5639.77
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
EPO
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
HMO
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
Medicaid
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
Medicare Part A
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
Medicare Part B
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
POS
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
PPO
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
humana - medicare advantage
Workers Comp
I
18325.66
3037.73
5228.44
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
EPO
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
HMO
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
Medicaid
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
Medicare Part A
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
Medicare Part B
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
POS
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
PPO
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
tricare
Workers Comp
I
18325.66
3037.73
3037.73
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
EPO
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
HMO
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
Medicaid
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
Medicare Part A
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
Medicare Part B
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
POS
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
PPO
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
united healthcare
Workers Comp
I
18325.66
3037.73
17270.31
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
EPO
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
HMO
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
Medicaid
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
Medicare Part A
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
Medicare Part B
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
POS
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
PPO
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
603
null
ms-drg
cellulitis without mcc
va
Workers Comp
I
18325.66
3037.73
6055.34
17270.31
10995.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
EPO
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
HMO
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
Medicaid
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
Medicare Part A
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
Medicare Part B
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
POS
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
PPO
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
60500
null
cpt
Removal or exploration of parathyroid glands
blue cross blue shield
Workers Comp
O
26439.06
11833.74
11833.74
11833.74
15863.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
EPO
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
HMO
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
Medicaid
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
Medicare Part A
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
Medicare Part B
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
POS
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
PPO
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
607
null
ms-drg
minor skin disorders without mcc
va
Workers Comp
I
12802.92
6028.16
6028.16
6028.16
7681.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
EPO
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
HMO
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
Medicaid
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
Medicare Part A
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
Medicare Part B
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
POS
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
PPO
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
616
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with mcc
blue cross blue shield
Workers Comp
I
81749.26
45483.75
45483.75
45483.75
49049.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
EPO
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
HMO
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
Medicaid
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
Medicare Part A
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
Medicare Part B
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
POS
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
PPO
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
aetna - medicare advantage
Workers Comp
I
42053.99
9593.57
12521.38
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
EPO
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
HMO
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
Medicaid
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
Medicare Part A
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
Medicare Part B
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
POS
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
PPO
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
blue cross blue shield
Workers Comp
I
42053.99
9593.57
20063.17
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
EPO
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
HMO
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicaid
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicare Part A
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicare Part B
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
POS
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
PPO
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Workers Comp
I
42053.99
9593.57
9593.57
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
EPO
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
HMO
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
Medicaid
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
Medicare Part A
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
Medicare Part B
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
POS
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
PPO
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
617
null
ms-drg
amputation of lower limb for endocrine nutritional and metabolic disorders with cc
united healthcare - medicare advantage
Workers Comp
I
42053.99
9593.57
12999.82
20063.17
25232.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
EPO
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
HMO
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
Medicaid
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
Medicare Part A
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
Medicare Part B
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
POS
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
PPO
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
619
null
ms-drg
o.r. procedures for obesity with mcc
humana - medicare advantage
Workers Comp
I
72066.92
84458.27
84458.27
84458.27
43240.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
EPO
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
HMO
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
Medicaid
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
Medicare Part A
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
Medicare Part B
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
POS
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
PPO
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
aetna
Workers Comp
I
49480.78
10746.01
10746.01
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
EPO
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
HMO
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
Medicaid
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
Medicare Part A
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
Medicare Part B
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
POS
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
PPO
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
blue cross blue shield
Workers Comp
I
49480.78
10746.01
20298.25
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
EPO
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
HMO
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
Medicaid
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
Medicare Part A
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
Medicare Part B
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
POS
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
PPO
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
620
null
ms-drg
o.r. procedures for obesity with cc
tricare
Workers Comp
I
49480.78
10746.01
11977.51
20298.25
29688.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
EPO
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
HMO
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
Medicaid
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
Medicare Part A
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
Medicare Part B
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
POS
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
PPO
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
blue cross blue shield
Workers Comp
I
44346.84
9984.55
18009.01
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
EPO
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
HMO
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
Medicaid
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
Medicare Part A
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
Medicare Part B
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
POS
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
PPO
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
humana - medicare advantage
Workers Comp
I
44346.84
9984.55
10219.65
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
EPO
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
HMO
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
Medicaid
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
Medicare Part A
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
Medicare Part B
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
POS
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
PPO
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
621
null
ms-drg
o.r. procedures for obesity without cc/mcc
tricare
Workers Comp
I
44346.84
9984.55
9984.55
18009.01
26608.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
EPO
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
HMO
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
Medicaid
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
Medicare Part A
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
Medicare Part B
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
POS
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
PPO
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
622
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with mcc
humana - medicare advantage
Workers Comp
I
57765.58
22420.04
22420.04
22420.04
34659.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
EPO
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
HMO
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
Medicaid
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
Medicare Part A
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
Medicare Part B
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
POS
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
PPO
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62270
null
cpt
Spinal tap for diagnosis
blue cross blue shield - medicare advantage
Workers Comp
O
1112.08
1036.13
1036.13
1036.13
667.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
EPO
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
HMO
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
Medicaid
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
POS
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
PPO
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
blue cross blue shield - medicare advantage
Workers Comp
I
46891.42
11327.00
15580.06
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
EPO
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
HMO
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicaid
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicare Part A
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Medicare Part B
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
POS
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
PPO
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
humana - medicare advantage
Workers Comp
I
46891.42
11327.00
11327.00
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
EPO
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
HMO
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
Medicaid
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
Medicare Part A
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
Medicare Part B
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
POS
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
PPO
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
623
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders with cc
medica
Workers Comp
I
46891.42
11327.00
15257.76
15580.06
28134.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
EPO
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
HMO
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
Medicaid
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
Medicare Part A
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
Medicare Part B
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
POS
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
PPO
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62302
null
cpt
X-ray of upper spinal canal with radiological supervision and interpretation
tricare
Workers Comp
O
6755.30
941.39
941.39
941.39
4053.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
EPO
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
HMO
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
Medicaid
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
Medicare Part A
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
Medicare Part B
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
POS
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
PPO
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
blue cross blue shield
Workers Comp
O
1439.61
553.72
1314.28
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
EPO
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
HMO
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
Medicaid
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
Medicare Part A
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
Medicare Part B
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
POS
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
PPO
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
humana - medicare advantage
Workers Comp
O
1439.61
553.72
557.87
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
EPO
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
HMO
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
Medicaid
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
Medicare Part A
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
Medicare Part B
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
POS
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
PPO
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
tricare
Workers Comp
O
1439.61
553.72
553.72
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
EPO
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
HMO
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
Medicaid
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
Medicare Part A
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
Medicare Part B
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
POS
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
PPO
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
united healthcare
Workers Comp
O
1439.61
553.72
1050.01
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
EPO
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
HMO
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
Medicaid
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
Medicare Part A
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
Medicare Part B
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
POS
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
PPO
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62320
null
cpt
Injection of substance into spinal canal of upper or middle back
va
Workers Comp
O
1439.61
553.72
562.00
1314.28
863.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
EPO
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
HMO
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
Medicaid
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
Medicare Part A
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
Medicare Part B
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
POS
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
PPO
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
aetna
Workers Comp
O
2040.75
516.39
1128.67
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
EPO
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
HMO
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
Medicaid
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
Medicare Part A
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
Medicare Part B
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
POS
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
PPO
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
blue cross blue shield
Workers Comp
O
2040.75
516.39
1291.57
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
EPO
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
HMO
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
Medicaid
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
Medicare Part A
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
Medicare Part B
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
POS
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
PPO
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
humana - medicare advantage
Workers Comp
O
2040.75
516.39
553.72
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
EPO
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
HMO
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
Medicaid
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
Medicare Part A
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
Medicare Part B
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
POS
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
PPO
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
tricare
Workers Comp
O
2040.75
516.39
516.39
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
EPO
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
HMO
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
Medicaid
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
Medicare Part A
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
Medicare Part B
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
POS
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
PPO
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
united healthcare
Workers Comp
O
2040.75
516.39
674.85
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
EPO
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
HMO
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
Medicaid
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
Medicare Part A
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
Medicare Part B
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
POS
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
PPO
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62321
null
cpt
Injection of substance into spinal canal of upper or middle back using imaging guidance
va
Workers Comp
O
2040.75
516.39
562.00
1291.57
1224.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
EPO
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
HMO
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
Medicaid
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
Medicare Part A
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
Medicare Part B
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
POS
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
PPO
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
blue cross blue shield
Workers Comp
O
1439.49
534.04
1183.55
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
EPO
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
HMO
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
Medicaid
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
Medicare Part A
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
Medicare Part B
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
POS
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
PPO
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
humana - medicare advantage
Workers Comp
O
1439.49
534.04
534.04
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
EPO
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
HMO
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
Medicaid
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
Medicare Part A
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
Medicare Part B
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
POS
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
PPO
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
tricare
Workers Comp
O
1439.49
534.04
553.72
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
EPO
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
HMO
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
Medicaid
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
Medicare Part A
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
Medicare Part B
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
POS
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
PPO
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
united healthcare
Workers Comp
O
1439.49
534.04
1477.69
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
EPO
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
HMO
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
Medicaid
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
Medicare Part A
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
Medicare Part B
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
POS
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
PPO
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62322
null
cpt
Lower spine injection using imaging guidance
va
Workers Comp
O
1439.49
534.04
562.00
1477.69
609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
EPO
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
HMO
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
Medicaid
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
Medicare Part A
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
Medicare Part B
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
POS
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
PPO
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield
Workers Comp
O
2040.51
553.72
1291.57
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
EPO
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
HMO
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
Medicaid
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
Medicare Part A
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
Medicare Part B
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
POS
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
PPO
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
blue cross blue shield - medicare advantage
Workers Comp
O
2040.51
553.72
1106.21
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
EPO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
HMO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
Medicaid
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
Medicare Part A
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
Medicare Part B
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
POS
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
PPO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
humana - medicare advantage
Workers Comp
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
EPO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
HMO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
Medicaid
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
Medicare Part A
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
Medicare Part B
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
POS
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
PPO
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
tricare
Workers Comp
O
2040.51
553.72
553.72
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
EPO
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
HMO
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
Medicaid
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
Medicare Part A
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
Medicare Part B
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
POS
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
PPO
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
united healthcare
Workers Comp
O
2040.51
553.72
1477.69
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
EPO
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
HMO
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
Medicaid
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
Medicare Part A
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
Medicare Part B
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
POS
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
PPO
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62323
null
cpt
Injection of substance into spinal canal of lower back or sacrum using imaging guidance b
va
Workers Comp
O
2040.51
553.72
559.92
1477.69
664.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
EPO
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
HMO
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
POS
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
PPO
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62328
null
cpt
Diagnostic spinal tap of lower spine using imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
1643.58
1036.13
1036.13
1036.13
986.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
EPO
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
HMO
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
Medicaid
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
Medicare Part A
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
Medicare Part B
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
POS
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
PPO
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62368
null
cpt
Electronic analysis and reprogramming of spinal canal drug infusion pump
tricare
Workers Comp
O
2370.69
239.99
239.99
239.99
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
EPO
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
HMO
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
Medicaid
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
Medicare Part A
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
Medicare Part B
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
POS
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
PPO
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
blue cross blue shield
Workers Comp
O
2370.69
241.31
252.17
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
EPO
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
HMO
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
Medicaid
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
Medicare Part A
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
Medicare Part B
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
POS
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
PPO
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
62370
null
cpt
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician
tricare
Workers Comp
O
2370.69
241.31
241.31
252.17
1422.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
POS
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
624
null
ms-drg
skin grafts and wound debridement for endocrine nutritional and metabolic disorders without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
15533.93
9766.08
9766.08
9766.08
9320.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
EPO
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
HMO
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
Medicaid
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
Medicare Part A
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
Medicare Part B
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
POS
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
PPO
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
627
null
ms-drg
thyroid parathyroid and thyroglossal procedures without cc/mcc
webtpa
Workers Comp
I
21877.25
15314.08
15314.08
15314.08
13126.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
EPO
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
HMO
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
Medicaid
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
Medicare Part A
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
Medicare Part B
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
POS
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
PPO
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
blue cross blue shield
Workers Comp
I
64981.51
9622.96
22145.04
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
EPO
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
HMO
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
Medicaid
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
Medicare Part A
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
Medicare Part B
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
POS
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
PPO
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
629
null
ms-drg
other endocrine nutritional and metabolic o.r. procedures with cc
humana - medicare advantage
Workers Comp
I
64981.51
9622.96
9622.96
22145.04
38988.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
EPO
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
HMO
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
Medicaid
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
Medicare Part A
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
Medicare Part B
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
POS
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
PPO
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
blue cross blue shield
Workers Comp
O
27203.73
5299.29
10903.98
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
EPO
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
HMO
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
Medicaid
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
Medicare Part A
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
Medicare Part B
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
POS
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
PPO
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
humana - medicare advantage
Workers Comp
O
27203.73
5299.29
11002.42
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
EPO
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
HMO
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
Medicaid
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
Medicare Part A
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
Medicare Part B
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
POS
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
PPO
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
tricare
Workers Comp
O
27203.73
5299.29
5299.29
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
EPO
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
HMO
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
Medicaid
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
Medicare Part A
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
Medicare Part B
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
POS
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
PPO
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
united healthcare
Workers Comp
O
27203.73
5299.29
19237.04
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
EPO
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
HMO
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
Medicaid
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
Medicare Part A
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
Medicare Part B
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
POS
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
PPO
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63030
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine
va
Workers Comp
O
27203.73
5299.29
16677.02
19237.04
16322.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
EPO
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
HMO
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
Medicaid
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
Medicare Part A
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
Medicare Part B
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
POS
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
PPO
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63035
null
cpt
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine
tricare
Workers Comp
O
30736.84
5548.49
5548.49
5548.49
18442.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
EPO
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
HMO
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
Medicaid
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
Medicare Part A
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
Medicare Part B
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
POS
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
PPO
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
humana - medicare advantage
Workers Comp
O
29158.95
5299.29
8109.18
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
EPO
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
HMO
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
Medicaid
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
Medicare Part A
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
Medicare Part B
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
POS
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
PPO
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63042
null
cpt
Re-exploration of spine repair with release of lower spinal cord or nerves single interspace
tricare
Workers Comp
O
29158.95
5299.29
5299.29
8109.18
17495.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
EPO
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
HMO
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicaid
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicare Part A
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicare Part B
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
POS
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
PPO
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63045
null
cpt
Partial removal of upper spine bone with release of spinal cord and/or nerves
blue cross blue shield
Workers Comp
O
24409.59
10932.64
10932.64
10932.64
14645.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
EPO
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
HMO
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
Medicaid
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
Medicare Part A
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
Medicare Part B
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
POS
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
PPO
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
blue cross blue shield
Workers Comp
O
27580.19
5299.29
10149.58
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
EPO
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
HMO
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
Medicaid
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
Medicare Part A
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
Medicare Part B
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
POS
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
PPO
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
humana - medicare advantage
Workers Comp
O
27580.19
5299.29
5299.29
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
EPO
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
HMO
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
Medicaid
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
Medicare Part A
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
Medicare Part B
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
POS
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
PPO
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
tricare
Workers Comp
O
27580.19
5299.29
5381.90
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
EPO
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
HMO
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
Medicaid
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
Medicare Part A
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
Medicare Part B
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
POS
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
PPO
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63047
null
cpt
Partial removal of middle spine bone with release of spinal cord and/or nerves lower back (lumbar) area
va
Workers Comp
O
27580.19
5299.29
8264.94
10149.58
16548.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
EPO
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
HMO
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicaid
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicare Part A
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
Medicare Part B
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
POS
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
PPO
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
blue cross blue shield
Workers Comp
O
26783.96
5299.29
10932.64
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
EPO
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
HMO
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
Medicaid
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
Medicare Part A
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
Medicare Part B
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
POS
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
PPO
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
humana - medicare advantage
Workers Comp
O
26783.96
5299.29
5548.49
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
EPO
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
HMO
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
Medicaid
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
Medicare Part A
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
Medicare Part B
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
POS
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
PPO
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
tricare
Workers Comp
O
26783.96
5299.29
5299.29
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
EPO
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
HMO
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
Medicaid
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
Medicare Part A
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
Medicare Part B
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
POS
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
PPO
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63048
null
cpt
Partial removal of spine bone with release of spinal cord and/or nerves
va
Workers Comp
O
26783.96
5299.29
11002.05
11002.05
16070.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
EPO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
HMO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
Medicaid
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
Medicare Part A
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
Medicare Part B
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
POS
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
PPO
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63081
null
cpt
Removal of upper spine bone with release of spinal cord and/or nerves anterior approach single segment
blue cross blue shield - medicare advantage
Workers Comp
O
66575.94
9449.91
9449.91
9449.91
39945.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
EPO
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
HMO
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
Medicaid
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
Medicare Part A
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
Medicare Part B
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
POS
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
PPO
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63267
null
cpt
Removal of lower spine bone and growth other than a tumor extradural
blue cross blue shield
Workers Comp
O
24370.67
10903.98
10903.98
10903.98
14622.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
EPO
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
HMO
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
Medicaid
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
Medicare Part A
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
Medicare Part B
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
POS
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
PPO
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63268
null
cpt
Removal of sacral spine bone and growth other than a tumor extradural
va
Workers Comp
O
119546.87
11002.05
11002.05
11002.05
71728.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
EPO
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
HMO
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
Medicaid
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
Medicare Part A
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
Medicare Part B
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
POS
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
PPO
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
63650
null
cpt
Implantation of spinal neurostimulator electrodes accessed through the skin
blue cross blue shield
Workers Comp
O
15478.86
8962.99
8962.99
8962.99
9287.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
EPO
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
HMO
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
Medicaid
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
Medicare Part A
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
Medicare Part B
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
POS
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
PPO
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield
Workers Comp
I
32245.58
6966.42
15575.93
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
EPO
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
HMO
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
Medicaid
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
POS
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
PPO
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
32245.58
6966.42
12763.74
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
EPO
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
HMO
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
Medicaid
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
Medicare Part A
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
Medicare Part B
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
POS
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
PPO
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
humana - medicare advantage
Workers Comp
I
32245.58
6966.42
8662.67
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
EPO
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
HMO
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
Medicaid
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
Medicare Part A
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
Medicare Part B
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
POS
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
PPO
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
tricare
Workers Comp
I
32245.58
6966.42
6966.42
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
EPO
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
HMO
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
Medicaid
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
Medicare Part A
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
Medicare Part B
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
POS
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
PPO
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
united healthcare - medicare advantage
Workers Comp
I
32245.58
6966.42
9013.56
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
EPO
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
HMO
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
Medicaid
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
Medicare Part A
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
Medicare Part B
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
POS
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
PPO
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
637
null
ms-drg
diabetes with mcc
webtpa
Workers Comp
I
32245.58
6966.42
16405.35
16405.35
19347.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
EPO
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
HMO
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
Medicaid
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
Medicare Part A
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
Medicare Part B
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
POS
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
PPO
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
aetna - medicare advantage
Workers Comp
I
19343.10
3915.43
6092.49
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
EPO
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
HMO
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
Medicaid
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
Medicare Part A
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
Medicare Part B
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
POS
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
PPO
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield
Workers Comp
I
19343.10
3915.43
8140.03
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
EPO
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
HMO
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
Medicaid
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
POS
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
PPO
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
blue cross blue shield - medicare advantage
Workers Comp
I
19343.10
3915.43
6792.83
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
EPO
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
HMO
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
Medicaid
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
Medicare Part A
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
Medicare Part B
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
POS
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
PPO
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
humana - medicare advantage
Workers Comp
I
19343.10
3915.43
5845.32
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
EPO
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
HMO
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
Medicaid
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
Medicare Part A
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
Medicare Part B
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
POS
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
PPO
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
tricare
Workers Comp
I
19343.10
3915.43
3915.43
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
EPO
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
HMO
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
Medicaid
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
Medicare Part A
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
Medicare Part B
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
POS
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
PPO
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
638
null
ms-drg
diabetes with cc
va
Workers Comp
I
19343.10
3915.43
5918.39
8140.03
11605.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
EPO
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
HMO
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
Medicaid
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
Medicare Part A
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
Medicare Part B
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
POS
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
PPO
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield
Workers Comp
I
16781.25
2760.03
6860.84
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
POS
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
16781.25
2760.03
5138.87
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
EPO
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
HMO
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
Medicaid
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
Medicare Part A
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
Medicare Part B
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
POS
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
PPO
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
639
null
ms-drg
diabetes without cc/mcc
tricare
Workers Comp
I
16781.25
2760.03
2760.03
6860.84
10068.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
EPO
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
HMO
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
Medicaid
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
Medicare Part A
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
Medicare Part B
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
POS
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
PPO
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
aetna - medicare advantage
Workers Comp
I
22966.14
6756.15
7898.94
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
EPO
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
HMO
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
Medicaid
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
Medicare Part A
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
Medicare Part B
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
POS
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
PPO
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
blue cross blue shield
Workers Comp
I
22966.14
6756.15
13189.50
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
EPO
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
HMO
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
Medicaid
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
Medicare Part A
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
Medicare Part B
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
POS
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
PPO
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
humana - medicare advantage
Workers Comp
I
22966.14
6756.15
6756.15
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
EPO
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
HMO
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
Medicaid
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
Medicare Part A
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
Medicare Part B
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
POS
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
PPO
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
tricare
Workers Comp
I
22966.14
6756.15
7357.45
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
EPO
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
HMO
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
Medicaid
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
Medicare Part A
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
Medicare Part B
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
POS
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
PPO
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
640
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes with mcc
va
Workers Comp
I
22966.14
6756.15
9009.71
13189.50
13779.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
EPO
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
HMO
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
Medicaid
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
Medicare Part A
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
Medicare Part B
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
POS
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
PPO
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield
Workers Comp
I
16363.63
3863.46
7764.29
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
EPO
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
HMO
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
Medicaid
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
POS
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
PPO
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
16363.63
3863.46
6280.67
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
EPO
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
HMO
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
Medicaid
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
Medicare Part A
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
Medicare Part B
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
POS
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
PPO
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
humana - medicare advantage
Workers Comp
I
16363.63
3863.46
5036.28
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
EPO
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
HMO
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
Medicaid
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
Medicare Part A
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
Medicare Part B
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
POS
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
PPO
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
tricare
Workers Comp
I
16363.63
3863.46
3863.46
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
EPO
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
HMO
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
Medicaid
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
Medicare Part A
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
Medicare Part B
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
POS
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
PPO
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
641
null
ms-drg
miscellaneous disorders of nutrition metabolism fluids and electrolytes without mcc
va
Workers Comp
I
16363.63
3863.46
5263.33
7764.29
9818.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
EPO
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
HMO
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
Medicaid
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
Medicare Part A
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
Medicare Part B
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
POS
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
PPO
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
643
null
ms-drg
endocrine disorders with mcc
humana - medicare advantage
Workers Comp
I
55343.10
10138.00
10138.00
10138.00
33205.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
EPO
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
HMO
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
Medicaid
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
Medicare Part A
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
Medicare Part B
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
POS
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
PPO
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
644
null
ms-drg
endocrine disorders with cc
humana - medicare advantage
Workers Comp
I
30441.38
4903.46
4903.46
4903.46
18264.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
EPO
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
HMO
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
Medicaid
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
Medicare Part A
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
Medicare Part B
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
POS
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
PPO
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield
Workers Comp
O
30653.95
2425.05
5636.14
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
EPO
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
HMO
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
Medicaid
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
Medicare Part A
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
Medicare Part B
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
POS
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
PPO
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
blue cross blue shield - medicare advantage
Workers Comp
O
30653.95
2425.05
12067.91
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
EPO
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
HMO
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
Medicaid
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
Medicare Part A
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
Medicare Part B
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
POS
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
PPO
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
humana - medicare advantage
Workers Comp
O
30653.95
2425.05
2425.05
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
EPO
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
HMO
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
Medicaid
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
Medicare Part A
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
Medicare Part B
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
POS
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
PPO
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64415
null
cpt
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm
tricare
Workers Comp
O
30653.95
2425.05
5299.29
12067.91
18392.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
EPO
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
HMO
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
Medicaid
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
Medicare Part A
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
Medicare Part B
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
POS
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
PPO
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64425
null
cpt
Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin
blue cross blue shield
Workers Comp
O
23773.30
9139.32
9139.32
9139.32
14263.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
EPO
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
HMO
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
Medicaid
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
Medicare Part A
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
Medicare Part B
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
POS
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
PPO
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
blue cross blue shield
Workers Comp
O
1386.79
261.74
5190.31
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
EPO
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
HMO
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
Medicaid
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
Medicare Part A
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
Medicare Part B
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
POS
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
PPO
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
tricare
Workers Comp
O
1386.79
261.74
1587.94
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
EPO
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
HMO
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
Medicaid
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
Medicare Part A
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
Medicare Part B
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
POS
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
PPO
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64450
null
cpt
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch
va
Workers Comp
O
1386.79
261.74
261.74
5190.31
832.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
EPO
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
HMO
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
Medicaid
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
Medicare Part A
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
Medicare Part B
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
POS
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
PPO
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
aetna
Workers Comp
O
2048.67
1064.77
1127.79
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
EPO
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
HMO
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
Medicaid
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
Medicare Part A
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
Medicare Part B
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
POS
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
PPO
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield
Workers Comp
O
2048.67
1064.77
2033.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
EPO
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
HMO
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
POS
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
PPO
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
2048.67
1064.77
1848.39
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
EPO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
HMO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
Medicaid
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
Medicare Part A
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
Medicare Part B
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
POS
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
PPO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
humana - medicare advantage
Workers Comp
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
EPO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
HMO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
Medicaid
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
Medicare Part A
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
Medicare Part B
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
POS
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
PPO
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
tricare
Workers Comp
O
2048.67
1064.77
1079.07
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
EPO
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
HMO
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
Medicaid
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
Medicare Part A
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
Medicare Part B
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
POS
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
PPO
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
united healthcare
Workers Comp
O
2048.67
1064.77
2189.43
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
EPO
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
HMO
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
Medicaid
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
Medicare Part A
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
Medicare Part B
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
POS
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
PPO
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
va
Workers Comp
O
2048.67
1064.77
1064.77
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
EPO
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
HMO
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
Medicaid
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
Medicare Part A
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
Medicare Part B
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
POS
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
PPO
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64483
null
cpt
Lower spine injection of steriod using imaging guidance
worker comp
Workers Comp
O
2048.67
1064.77
1405.83
2189.43
1274.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
EPO
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
HMO
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
Medicaid
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
Medicare Part A
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
Medicare Part B
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
POS
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
PPO
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
aetna
Workers Comp
O
12159.95
1064.77
7904.05
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
EPO
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
HMO
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
Medicaid
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
Medicare Part A
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
Medicare Part B
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
POS
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
PPO
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
blue cross blue shield
Workers Comp
O
12159.95
1064.77
2174.81
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
EPO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
HMO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
Medicaid
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
Medicare Part A
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
Medicare Part B
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
POS
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
PPO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
humana - medicare advantage
Workers Comp
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
EPO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
HMO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
Medicaid
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
Medicare Part A
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
Medicare Part B
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
POS
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
PPO
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
tricare
Workers Comp
O
12159.95
1064.77
1079.07
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
EPO
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
HMO
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
Medicaid
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
Medicare Part A
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
Medicare Part B
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
POS
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
PPO
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
united healthcare
Workers Comp
O
12159.95
1064.77
5594.41
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
EPO
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
HMO
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
Medicaid
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
Medicare Part A
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
Medicare Part B
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
POS
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
PPO
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64484
null
cpt
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance each additional level
va
Workers Comp
O
12159.95
1064.77
1064.77
7904.05
7295.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
EPO
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
HMO
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
Medicaid
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
Medicare Part A
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
Medicare Part B
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
POS
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
PPO
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield
Workers Comp
O
4828.39
719.38
2100.95
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
EPO
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
HMO
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicaid
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicare Part A
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicare Part B
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
POS
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
PPO
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Workers Comp
O
4828.39
719.38
1637.31
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
EPO
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
HMO
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
Medicaid
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
Medicare Part A
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
Medicare Part B
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
POS
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
PPO
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64490
null
cpt
Injections of upper or middle spine facet joint using imaging guidance single level
tricare
Workers Comp
O
4828.39
719.38
719.38
2100.95
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
EPO
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
HMO
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicaid
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicare Part A
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicare Part B
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
POS
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
PPO
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64491
null
cpt
Injections of upper or middle spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Workers Comp
O
4828.39
1637.31
1637.31
1637.31
2897.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
EPO
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
HMO
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
Medicaid
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
Medicare Part A
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
Medicare Part B
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
POS
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
PPO
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna
Workers Comp
O
4066.84
676.38
3530.58
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
EPO
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
HMO
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
Medicaid
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
Medicare Part A
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
Medicare Part B
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
POS
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
PPO
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
aetna - medicare advantage
Workers Comp
O
4066.84
676.38
676.38
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
EPO
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
HMO
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
Medicaid
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
Medicare Part A
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
Medicare Part B
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
POS
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
PPO
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield
Workers Comp
O
4066.84
676.38
2117.04
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
EPO
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
HMO
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicaid
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicare Part A
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Medicare Part B
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
POS
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
PPO
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
blue cross blue shield - medicare advantage
Workers Comp
O
4066.84
676.38
1523.98
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
EPO
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
HMO
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
Medicaid
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
Medicare Part A
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
Medicare Part B
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
POS
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
PPO
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
humana - medicare advantage
Workers Comp
O
4066.84
676.38
890.59
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
EPO
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
HMO
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
Medicaid
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
Medicare Part A
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
Medicare Part B
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
POS
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
PPO
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
tricare
Workers Comp
O
4066.84
676.38
1079.07
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
EPO
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
HMO
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
Medicaid
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
Medicare Part A
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
Medicare Part B
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
POS
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
PPO
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
united healthcare
Workers Comp
O
4066.84
676.38
1415.24
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
EPO
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
HMO
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
Medicaid
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
Medicare Part A
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
Medicare Part B
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
POS
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
PPO
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64493
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance single level
va
Workers Comp
O
4066.84
676.38
1092.57
3530.58
2440.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
EPO
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
HMO
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
Medicaid
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
Medicare Part A
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
Medicare Part B
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
POS
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
PPO
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna
Workers Comp
O
4073.59
518.70
3530.58
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
EPO
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
HMO
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
Medicaid
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
Medicare Part A
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
Medicare Part B
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
POS
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
PPO
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
aetna - medicare advantage
Workers Comp
O
4073.59
518.70
676.38
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
EPO
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
HMO
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
Medicaid
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
Medicare Part A
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
Medicare Part B
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
POS
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
PPO
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield
Workers Comp
O
4073.59
518.70
1799.19
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
EPO
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
HMO
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicaid
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicare Part A
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Medicare Part B
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
POS
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
PPO
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
blue cross blue shield - medicare advantage
Workers Comp
O
4073.59
518.70
1523.98
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
EPO
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
HMO
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
Medicaid
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
Medicare Part A
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
Medicare Part B
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
POS
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
PPO
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
humana - medicare advantage
Workers Comp
O
4073.59
518.70
1061.80
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
EPO
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
HMO
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
Medicaid
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
Medicare Part A
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
Medicare Part B
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
POS
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
PPO
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
tricare
Workers Comp
O
4073.59
518.70
1079.07
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
EPO
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
HMO
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
Medicaid
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
Medicare Part A
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
Medicare Part B
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
POS
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
PPO
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
united healthcare
Workers Comp
O
4073.59
518.70
518.70
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
EPO
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
HMO
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
Medicaid
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
Medicare Part A
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
Medicare Part B
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
POS
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
PPO
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64494
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance second level
va
Workers Comp
O
4073.59
518.70
1092.57
3530.58
2444.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
EPO
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
HMO
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
Medicaid
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
Medicare Part A
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
Medicare Part B
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
POS
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
PPO
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna
Workers Comp
O
4075.00
518.70
3530.58
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
EPO
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
HMO
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
Medicaid
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
Medicare Part A
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
Medicare Part B
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
POS
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
PPO
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
aetna - medicare advantage
Workers Comp
O
4075.00
518.70
705.71
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
EPO
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
HMO
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
Medicaid
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
Medicare Part A
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
Medicare Part B
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
POS
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
PPO
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield
Workers Comp
O
4075.00
518.70
1799.19
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
EPO
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
HMO
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
Medicaid
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
Medicare Part A
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
Medicare Part B
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
POS
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
PPO
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
blue cross blue shield - medicare advantage
Workers Comp
O
4075.00
518.70
1523.98
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
EPO
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
HMO
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
Medicaid
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
Medicare Part A
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
Medicare Part B
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
POS
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
PPO
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
humana - medicare advantage
Workers Comp
O
4075.00
518.70
899.23
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
EPO
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
HMO
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
Medicaid
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
Medicare Part A
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
Medicare Part B
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
POS
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
PPO
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
tricare
Workers Comp
O
4075.00
518.70
1079.07
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
EPO
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
HMO
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
Medicaid
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
Medicare Part A
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
Medicare Part B
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
POS
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
PPO
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64495
null
cpt
Injections of lower or sacral spine facet joint using imaging guidance third and any additional level(s)
united healthcare
Workers Comp
O
4075.00
518.70
518.70
3530.58
2445.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
EPO
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
HMO
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
Medicaid
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
Medicare Part A
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
Medicare Part B
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
POS
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
PPO
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield
Workers Comp
O
4743.36
1553.76
2097.81
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
EPO
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
HMO
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
POS
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
PPO
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
4743.36
1553.76
1802.40
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
EPO
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
HMO
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
Medicaid
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
Medicare Part A
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
Medicare Part B
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
POS
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
PPO
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64624
null
cpt
Destruction of genicular nerve branches of knee by injection using imaging guidance
humana - medicare advantage
Workers Comp
O
4743.36
1553.76
1553.76
2097.81
2846.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
EPO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
HMO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
Medicaid
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
Medicare Part A
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
Medicare Part B
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
POS
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
PPO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield
Workers Comp
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
EPO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
HMO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
POS
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
PPO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
EPO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
HMO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
Medicaid
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
Medicare Part A
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
Medicare Part B
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
POS
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
PPO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
humana - medicare advantage
Workers Comp
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
EPO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
HMO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
Medicaid
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
Medicare Part A
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
Medicare Part B
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
POS
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
PPO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
tricare
Workers Comp
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
EPO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
HMO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
Medicaid
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
Medicare Part A
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
Medicare Part B
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
POS
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
PPO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64635
null
cpt
Destruction of lower or sacral spinal facet joint nerves using imaging guidance
va
Workers Comp
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
EPO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
HMO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
Medicaid
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
Medicare Part A
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
Medicare Part B
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
POS
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
PPO
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield
Workers Comp
O
7006.26
4.38
1951.88
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
EPO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
HMO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
POS
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
PPO
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
7006.26
4.38
4.38
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
EPO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
HMO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
Medicaid
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
Medicare Part A
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
Medicare Part B
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
POS
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
PPO
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
humana - medicare advantage
Workers Comp
O
7006.26
4.38
1553.76
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
EPO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
HMO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
Medicaid
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
Medicare Part A
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
Medicare Part B
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
POS
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
PPO
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
tricare
Workers Comp
O
7006.26
4.38
1523.14
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
EPO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
HMO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
Medicaid
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
Medicare Part A
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
Medicare Part B
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
POS
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
PPO
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64636
null
cpt
Destruction of lower or sacral spinal facet joint nerves with imaging guidance
va
Workers Comp
O
7006.26
4.38
1553.71
1951.88
4203.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
EPO
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
HMO
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
Medicaid
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
Medicare Part A
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
Medicare Part B
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
POS
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
PPO
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64708
null
cpt
Release of nerve of arm or leg open procedure
tricare
Workers Comp
O
17488.07
1523.14
1523.14
1523.14
10492.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
EPO
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
HMO
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
Medicaid
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
Medicare Part A
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
Medicare Part B
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
POS
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
PPO
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
aetna
Workers Comp
O
16109.50
1523.14
9879.47
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
EPO
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
HMO
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
Medicaid
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
Medicare Part A
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
Medicare Part B
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
POS
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
PPO
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield
Workers Comp
O
16109.50
1523.14
5125.32
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
EPO
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
HMO
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
Medicaid
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
Medicare Part A
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
Medicare Part B
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
POS
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
PPO
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
blue cross blue shield - medicare advantage
Workers Comp
O
16109.50
1523.14
4454.53
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
EPO
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
HMO
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
Medicaid
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
Medicare Part A
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
Medicare Part B
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
POS
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
PPO
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
humana - medicare advantage
Workers Comp
O
16109.50
1523.14
1538.45
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
EPO
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
HMO
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
Medicaid
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
Medicare Part A
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
Medicare Part B
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
POS
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
PPO
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
tricare
Workers Comp
O
16109.50
1523.14
1523.14
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
EPO
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
HMO
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
Medicaid
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
Medicare Part A
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
Medicare Part B
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
POS
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
PPO
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
united healthcare
Workers Comp
O
16109.50
1523.14
10707.28
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
EPO
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
HMO
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
Medicaid
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
Medicare Part A
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
Medicare Part B
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
POS
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
PPO
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64718
null
cpt
Release and/or relocation of ulnar nerve at elbow
va
Workers Comp
O
16109.50
1523.14
1553.71
10707.28
9665.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
EPO
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
HMO
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
Medicaid
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
Medicare Part A
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
Medicare Part B
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
POS
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
PPO
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna
Workers Comp
O
14463.72
1523.14
8196.62
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
EPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
HMO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
Medicaid
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
Medicare Part A
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
Medicare Part B
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
POS
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
PPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
aetna - medicare advantage
Workers Comp
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
EPO
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
HMO
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
Medicaid
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
Medicare Part A
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
Medicare Part B
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
POS
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
PPO
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield
Workers Comp
O
14463.72
1523.14
5112.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
EPO
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
HMO
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
Medicaid
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
Medicare Part A
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
Medicare Part B
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
POS
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
PPO
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
blue cross blue shield - medicare advantage
Workers Comp
O
14463.72
1523.14
3794.74
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
EPO
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
HMO
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
Medicaid
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
Medicare Part A
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
Medicare Part B
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
POS
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
PPO
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
cigna
Workers Comp
O
14463.72
1523.14
8738.10
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
EPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
HMO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
Medicaid
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
Medicare Part A
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
Medicare Part B
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
POS
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
PPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
humana - medicare advantage
Workers Comp
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
EPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
HMO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
Medicaid
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
Medicare Part A
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
Medicare Part B
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
POS
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
PPO
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
tricare
Workers Comp
O
14463.72
1523.14
1523.14
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
EPO
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
HMO
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
Medicaid
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
Medicare Part A
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
Medicare Part B
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
POS
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
PPO
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
united healthcare
Workers Comp
O
14463.72
1523.14
10707.28
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
EPO
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
HMO
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
Medicaid
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
Medicare Part A
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
Medicare Part B
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
POS
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
PPO
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
64721
null
cpt
Release and/or relocation of median nerve of hand
va
Workers Comp
O
14463.72
1523.14
1553.71
10707.28
8678.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
EPO
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
HMO
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
Medicaid
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
Medicare Part A
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
Medicare Part B
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
POS
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
PPO
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65426
null
cpt
Removal or relocation of corneal conjunctiva with graft
tricare
Workers Comp
O
17210.30
1714.35
1714.35
1714.35
10326.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
EPO
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
HMO
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
Medicaid
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
Medicare Part A
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
Medicare Part B
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
POS
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
PPO
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
tricare
Workers Comp
I
49307.53
12022.73
13552.29
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
EPO
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
HMO
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
Medicaid
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
Medicare Part A
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
Medicare Part B
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
POS
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
PPO
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
657
null
ms-drg
kidney and ureter procedures for neoplasm with cc
united healthcare - medicare advantage
Workers Comp
I
49307.53
12022.73
12022.73
13552.29
29584.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
EPO
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
HMO
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
Medicaid
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
Medicare Part A
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
Medicare Part B
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
POS
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
PPO
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65771
null
cpt
Incisions in cornea to correct refraction error
united healthcare - medicare advantage
Workers Comp
O
12731.39
2923.00
2923.00
2923.00
7638.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
EPO
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
HMO
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
Medicaid
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
Medicare Part A
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
Medicare Part B
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
POS
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
PPO
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
658
null
ms-drg
kidney and ureter procedures for neoplasm without cc/mcc
aetna - medicare advantage
Workers Comp
I
36982.16
8341.24
8341.24
8341.24
22189.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
EPO
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
HMO
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
Medicaid
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
Medicare Part A
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
Medicare Part B
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
POS
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
PPO
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
humana - medicare advantage
Workers Comp
I
65191.26
14613.27
14613.27
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
EPO
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
HMO
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
Medicaid
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
Medicare Part A
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
Medicare Part B
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
POS
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
PPO
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
659
null
ms-drg
kidney and ureter procedures for non-neoplasm with mcc
va
Workers Comp
I
65191.26
14613.27
18119.90
18119.90
39114.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
EPO
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
HMO
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
Medicaid
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
Medicare Part A
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
Medicare Part B
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
POS
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
PPO
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
65920
null
cpt
Removal of implanted lens in eye
blue cross blue shield
Workers Comp
O
12922.65
5577.49
5577.49
5577.49
7753.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
EPO
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
HMO
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
Medicaid
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
Medicare Part A
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
Medicare Part B
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
POS
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
PPO
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield
Workers Comp
I
40587.85
14725.09
17145.50
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
EPO
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
HMO
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
Medicaid
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
POS
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
PPO
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
660
null
ms-drg
kidney and ureter procedures for non-neoplasm with cc
blue cross blue shield - medicare advantage
Workers Comp
I
40587.85
14725.09
14725.09
17145.50
24352.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
EPO
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
HMO
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
Medicaid
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
Medicare Part A
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
Medicare Part B
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
POS
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
PPO
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
661
null
ms-drg
kidney and ureter procedures for non-neoplasm without cc/mcc
blue cross blue shield
Workers Comp
I
27258.50
16357.50
16357.50
16357.50
16355.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
EPO
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
HMO
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
Medicaid
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
Medicare Part A
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
Medicare Part B
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
POS
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
PPO
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66825
null
cpt
Repositioning of lens prosthesis
blue cross blue shield
Workers Comp
O
13657.80
3724.52
3724.52
3724.52
8194.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
EPO
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
HMO
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
Medicaid
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
Medicare Part A
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
Medicare Part B
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
POS
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
PPO
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
669
null
ms-drg
transurethral procedures with cc
humana - medicare advantage
Workers Comp
I
67783.24
9728.02
9728.02
9728.02
40669.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
EPO
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
HMO
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
Medicaid
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
Medicare Part A
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
Medicare Part B
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
POS
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
PPO
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
blue cross blue shield
Workers Comp
O
15468.46
1841.32
4774.93
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
EPO
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
HMO
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
Medicaid
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
Medicare Part A
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
Medicare Part B
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
POS
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
PPO
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
humana - medicare advantage
Workers Comp
O
15468.46
1841.32
1841.39
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
EPO
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
HMO
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
Medicaid
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
Medicare Part A
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
Medicare Part B
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
POS
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
PPO
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
tricare
Workers Comp
O
15468.46
1841.32
3382.58
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
EPO
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
HMO
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
Medicaid
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
Medicare Part A
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
Medicare Part B
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
POS
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
PPO
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66982
null
cpt
Removal of cataract with insertion of lens complex
va
Workers Comp
O
15468.46
1841.32
1841.32
4774.93
9281.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
EPO
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
HMO
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
Medicaid
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
Medicare Part A
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
Medicare Part B
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
POS
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
PPO
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna
Workers Comp
O
14136.53
1623.29
4435.54
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
EPO
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
HMO
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
Medicaid
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
Medicare Part A
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
Medicare Part B
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
POS
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
PPO
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
aetna - medicare advantage
Workers Comp
O
14136.53
1623.29
3296.22
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
EPO
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
HMO
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
Medicaid
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
Medicare Part A
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
Medicare Part B
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
POS
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
PPO
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield
Workers Comp
O
14136.53
1623.29
4337.53
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
EPO
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
HMO
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
Medicaid
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
Medicare Part A
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
Medicare Part B
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
POS
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
PPO
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
blue cross blue shield - medicare advantage
Workers Comp
O
14136.53
1623.29
3152.06
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
EPO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
HMO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
Medicaid
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
Medicare Part A
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
Medicare Part B
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
POS
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
PPO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
humana - medicare advantage
Workers Comp
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
EPO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
HMO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
Medicaid
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
Medicare Part A
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
Medicare Part B
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
POS
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
PPO
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
tricare
Workers Comp
O
14136.53
1623.29
1791.13
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
EPO
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
HMO
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
Medicaid
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
Medicare Part A
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
Medicare Part B
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
POS
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
PPO
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
united healthcare - medicare advantage
Workers Comp
O
14136.53
1623.29
1623.29
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
EPO
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
HMO
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
Medicaid
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
Medicare Part A
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
Medicare Part B
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
POS
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
PPO
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
66984
null
cpt
Removal of cataract with insertion of lens
va
Workers Comp
O
14136.53
1623.29
1841.32
4435.54
8481.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
EPO
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
HMO
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
Medicaid
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
Medicare Part A
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
Medicare Part B
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
POS
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
PPO
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
67010
null
cpt
Partial removal of eye fluid between the lens and retina subtotal removal with mechanical vitrectomy
humana - medicare advantage
Workers Comp
O
27113.24
1791.13
1791.13
1791.13
16267.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
EPO
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
HMO
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
Medicaid
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
Medicare Part A
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
Medicare Part B
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
POS
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
PPO
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
humana - medicare advantage
Workers Comp
I
61701.73
12690.24
50281.04
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
EPO
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
HMO
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
Medicaid
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
Medicare Part A
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
Medicare Part B
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
POS
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
PPO
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
673
null
ms-drg
other kidney and urinary tract procedures with mcc
tricare
Workers Comp
I
61701.73
12690.24
12690.24
50281.04
37021.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
EPO
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
HMO
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
Medicaid
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
Medicare Part A
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
Medicare Part B
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
POS
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
PPO
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield
Workers Comp
I
37593.94
20589.05
20589.05
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
EPO
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
HMO
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
Medicaid
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
POS
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
PPO
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
674
null
ms-drg
other kidney and urinary tract procedures with cc
blue cross blue shield - medicare advantage
Workers Comp
I
37593.94
20589.05
22706.33
22706.33
22556.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
EPO
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
HMO
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
Medicaid
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
Medicare Part A
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
Medicare Part B
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
POS
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
PPO
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
blue cross blue shield
Workers Comp
I
24568.57
8872.93
17296.27
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
EPO
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
HMO
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
Medicaid
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
Medicare Part A
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
Medicare Part B
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
POS
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
PPO
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
humana - medicare advantage
Workers Comp
I
24568.57
8872.93
8872.93
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
EPO
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
HMO
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
Medicaid
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
Medicare Part A
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
Medicare Part B
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
POS
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
PPO
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
682
null
ms-drg
renal failure with mcc
va
Workers Comp
I
24568.57
8872.93
9340.50
17296.27
14741.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
EPO
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
HMO
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
Medicaid
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
Medicare Part A
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
Medicare Part B
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
POS
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
PPO
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
aetna - medicare advantage
Workers Comp
I
17044.05
4708.20
6088.31
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
EPO
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
HMO
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
Medicaid
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
Medicare Part A
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
Medicare Part B
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
POS
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
PPO
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield
Workers Comp
I
17044.05
4708.20
10150.70
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
EPO
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
HMO
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
Medicaid
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
POS
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
PPO
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
blue cross blue shield - medicare advantage
Workers Comp
I
17044.05
4708.20
8891.11
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
EPO
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
HMO
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
Medicaid
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
Medicare Part A
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
Medicare Part B
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
POS
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
PPO
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
humana - medicare advantage
Workers Comp
I
17044.05
4708.20
6211.69
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
EPO
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
HMO
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
Medicaid
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
Medicare Part A
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
Medicare Part B
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
POS
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
PPO
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
tricare
Workers Comp
I
17044.05
4708.20
4708.20
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
EPO
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
HMO
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
Medicaid
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
Medicare Part A
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
Medicare Part B
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
POS
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
PPO
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
683
null
ms-drg
renal failure with cc
va
Workers Comp
I
17044.05
4708.20
6016.60
10150.70
10226.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
EPO
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
HMO
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
Medicaid
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
Medicare Part A
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
Medicare Part B
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
POS
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
PPO
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
684
null
ms-drg
renal failure without cc/mcc
tricare
Workers Comp
I
13312.03
3036.64
3036.64
3036.64
7987.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
EPO
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
HMO
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
Medicaid
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
Medicare Part A
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
Medicare Part B
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
POS
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
PPO
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
aetna - medicare advantage
Workers Comp
I
22450.36
6414.21
7717.72
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
EPO
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
HMO
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
Medicaid
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
Medicare Part A
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
Medicare Part B
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
POS
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
PPO
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield
Workers Comp
I
22450.36
6414.21
9982.15
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
EPO
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
HMO
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
Medicaid
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
POS
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
PPO
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
22450.36
6414.21
10770.67
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
EPO
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
HMO
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
Medicaid
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
Medicare Part A
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
Medicare Part B
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
POS
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
PPO
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
humana - medicare advantage
Workers Comp
I
22450.36
6414.21
6760.19
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
EPO
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
HMO
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
Medicaid
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
Medicare Part A
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
Medicare Part B
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
POS
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
PPO
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
tricare
Workers Comp
I
22450.36
6414.21
6414.21
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
EPO
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
HMO
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
Medicaid
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
Medicare Part A
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
Medicare Part B
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
POS
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
PPO
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
united healthcare - medicare advantage
Workers Comp
I
22450.36
6414.21
7109.98
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
EPO
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
HMO
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
Medicaid
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
Medicare Part A
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
Medicare Part B
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
POS
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
PPO
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
689
null
ms-drg
kidney and urinary tract infections with mcc
va
Workers Comp
I
22450.36
6414.21
8339.50
10770.67
13470.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
EPO
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
HMO
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
Medicaid
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
Medicare Part A
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
Medicare Part B
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
POS
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
PPO
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield
Workers Comp
I
15349.48
3735.53
8267.97
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
EPO
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
HMO
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
Medicaid
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
POS
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
PPO
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
15349.48
3735.53
5807.14
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
EPO
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
HMO
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
Medicaid
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
Medicare Part A
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
Medicare Part B
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
POS
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
PPO
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
humana - medicare advantage
Workers Comp
I
15349.48
3735.53
5739.33
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
EPO
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
HMO
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
Medicaid
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
Medicare Part A
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
Medicare Part B
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
POS
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
PPO
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
tricare
Workers Comp
I
15349.48
3735.53
3735.53
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
EPO
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
HMO
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
Medicaid
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
Medicare Part A
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
Medicare Part B
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
POS
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
PPO
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
va
Workers Comp
I
15349.48
3735.53
5519.01
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
EPO
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
HMO
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
Medicaid
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
Medicare Part A
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
Medicare Part B
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
POS
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
PPO
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
690
null
ms-drg
kidney and urinary tract infections without mcc
webtpa
Workers Comp
I
15349.48
3735.53
16123.23
16123.23
9209.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
EPO
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
HMO
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
Medicaid
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
Medicare Part A
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
Medicare Part B
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
POS
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
PPO
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69100
null
cpt
Biopsy of ear
blue cross blue shield
Workers Comp
O
2890.00
1044.00
1044.00
1044.00
1734.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
EPO
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
HMO
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
Medicaid
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
Medicare Part A
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
Medicare Part B
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
POS
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
PPO
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69145
null
cpt
Removal of soft tissue growth of ear canal
tricare
Workers Comp
O
9628.90
2054.26
2054.26
2054.26
5777.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
EPO
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
HMO
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
Medicaid
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
Medicare Part A
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
Medicare Part B
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
POS
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
PPO
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
blue cross blue shield
Workers Comp
I
11187.42
3248.11
7980.79
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
EPO
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
HMO
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
Medicaid
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
Medicare Part A
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
Medicare Part B
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
POS
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
PPO
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
tricare
Workers Comp
I
11187.42
3248.11
3248.11
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
EPO
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
HMO
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
Medicaid
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
Medicare Part A
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
Medicare Part B
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
POS
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
PPO
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
694
null
ms-drg
urinary stones without mcc
webtpa
Workers Comp
I
11187.42
3248.11
4873.85
7980.79
6712.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
EPO
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
HMO
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
Medicaid
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
Medicare Part A
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
Medicare Part B
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
POS
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
PPO
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
humana - medicare advantage
Workers Comp
O
11396.82
2054.26
2320.38
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
EPO
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
HMO
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
Medicaid
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
Medicare Part A
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
Medicare Part B
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
POS
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
PPO
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69424
null
cpt
Removal of implanted eardrum tube under anesthesia
tricare
Workers Comp
O
11396.82
2054.26
2054.26
2320.38
6838.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
EPO
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
HMO
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
Medicaid
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
Medicare Part A
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
Medicare Part B
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
POS
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
PPO
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69436
null
cpt
Incision of eardrum with insertion of eardrum tube under general anesthesia
humana - medicare advantage
Workers Comp
O
11403.59
958.46
958.46
958.46
6842.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
EPO
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
HMO
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
Medicaid
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
Medicare Part A
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
Medicare Part B
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
POS
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
PPO
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
humana - medicare advantage
Workers Comp
I
27124.88
9816.57
9816.57
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
EPO
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
HMO
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
Medicaid
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
Medicare Part A
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
Medicare Part B
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
POS
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
PPO
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
va
Workers Comp
I
27124.88
9816.57
11301.11
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
EPO
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
HMO
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
Medicaid
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
Medicare Part A
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
Medicare Part B
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
POS
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
PPO
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
698
null
ms-drg
other kidney and urinary tract diagnoses with mcc
webtpa
Workers Comp
I
27124.88
9816.57
17445.39
17445.39
16274.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
EPO
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
HMO
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
Medicaid
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
POS
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
PPO
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
blue cross blue shield - medicare advantage
Workers Comp
I
20283.72
6258.60
8117.22
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
EPO
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
HMO
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
Medicaid
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
Medicare Part A
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
Medicare Part B
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
POS
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
PPO
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
humana - medicare advantage
Workers Comp
I
20283.72
6258.60
6258.60
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
EPO
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
HMO
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
Medicaid
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
Medicare Part A
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
Medicare Part B
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
POS
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
PPO
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
699
null
ms-drg
other kidney and urinary tract diagnoses with cc
va
Workers Comp
I
20283.72
6258.60
7228.86
8117.22
12170.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
EPO
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
HMO
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
Medicaid
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
Medicare Part A
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
Medicare Part B
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
POS
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
PPO
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
blue cross blue shield
Workers Comp
O
14100.79
1523.14
5773.69
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
EPO
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
HMO
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
Medicaid
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
Medicare Part A
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
Medicare Part B
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
POS
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
PPO
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
69990
null
cpt
Use of operating microscope
tricare
Workers Comp
O
14100.79
1523.14
1523.14
5773.69
8460.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
EPO
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
HMO
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
Medicaid
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
Medicare Part A
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
Medicare Part B
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
POS
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
PPO
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
blue cross blue shield
Workers Comp
I
14171.12
5336.25
5405.71
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
EPO
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
HMO
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
Medicaid
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
Medicare Part A
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
Medicare Part B
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
POS
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
PPO
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
700
null
ms-drg
other kidney and urinary tract diagnoses without cc/mcc
va
Workers Comp
I
14171.12
5336.25
5336.25
5405.71
8502.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
EPO
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
HMO
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
Medicaid
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
Medicare Part A
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
Medicare Part B
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
POS
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
PPO
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
blue cross blue shield
Workers Comp
O
388.43
70.78
70.78
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
EPO
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
HMO
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
Medicaid
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
Medicare Part A
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
Medicare Part B
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
POS
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
PPO
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70110
null
cpt
X-ray of mandible minimum of 4 views
humana - medicare advantage
Workers Comp
O
388.43
70.78
99.29
99.29
233.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
EPO
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
HMO
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
Medicaid
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
Medicare Part A
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
Medicare Part B
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
POS
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
PPO
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70130
null
cpt
X-ray of mastoid minimum of 3 views per side
blue cross blue shield - medicare advantage
Workers Comp
O
302.73
61.44
61.44
61.44
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
EPO
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
HMO
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
Medicaid
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
Medicare Part A
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
Medicare Part B
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
POS
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
PPO
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
aetna - medicare advantage
Workers Comp
O
440.74
98.30
98.30
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
EPO
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
HMO
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
Medicaid
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
Medicare Part A
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
Medicare Part B
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
POS
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
PPO
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
humana - medicare advantage
Workers Comp
O
440.74
98.30
99.29
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
EPO
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
HMO
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
Medicaid
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
Medicare Part A
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
Medicare Part B
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
POS
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
PPO
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70150
null
cpt
X-ray of bones of face minimum of 3 views
worker comp
Workers Comp
O
440.74
98.30
314.82
314.82
264.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
EPO
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
HMO
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
Medicaid
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
Medicare Part A
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
Medicare Part B
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
POS
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
PPO
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70160
null
cpt
X-ray of bones of nose minimum of 3 views
tricare
Workers Comp
O
291.60
70.70
70.70
70.70
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
EPO
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
HMO
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
Medicaid
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
Medicare Part A
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
Medicare Part B
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
POS
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
PPO
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield
Workers Comp
O
322.77
47.22
151.60
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
322.77
47.22
47.22
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
EPO
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
HMO
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
Medicaid
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
Medicare Part A
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
Medicare Part B
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
POS
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
PPO
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
humana - medicare advantage
Workers Comp
O
322.77
47.22
71.65
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
EPO
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
HMO
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
Medicaid
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
Medicare Part A
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
Medicare Part B
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
POS
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
PPO
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
tricare
Workers Comp
O
322.77
47.22
53.73
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
EPO
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
HMO
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
Medicaid
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
Medicare Part A
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
Medicare Part B
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
POS
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
PPO
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70220
null
cpt
X-ray of paranasal sinus complete minimum of 3 views
webtpa
Workers Comp
O
322.77
47.22
225.94
225.94
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
EPO
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
HMO
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
Medicaid
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
Medicare Part A
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
Medicare Part B
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
POS
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
PPO
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
blue cross blue shield
Workers Comp
O
479.70
61.44
61.44
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
EPO
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
HMO
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
Medicaid
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
Medicare Part A
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
Medicare Part B
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
POS
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
PPO
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
humana - medicare advantage
Workers Comp
O
479.70
61.44
96.51
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
EPO
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
HMO
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
Medicaid
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
Medicare Part A
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
Medicare Part B
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
POS
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
PPO
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70260
null
cpt
X-ray of skull complete minimum of 4 views
united healthcare
Workers Comp
O
479.70
61.44
342.65
342.65
287.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
EPO
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
HMO
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
Medicaid
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
Medicare Part A
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
Medicare Part B
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
POS
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
PPO
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70330
null
cpt
X-ray of jaw joints on both sides of the face
blue cross blue shield
Workers Comp
O
322.77
61.44
61.44
61.44
193.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
EPO
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
HMO
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
Medicaid
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
Medicare Part A
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
Medicare Part B
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
POS
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
PPO
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70336
null
cpt
MRI scan of jaw joints
blue cross blue shield - medicare advantage
Workers Comp
O
1763.76
1763.76
1763.76
1763.76
1058.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
EPO
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
HMO
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
Medicaid
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
POS
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
PPO
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
61.44
61.44
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
EPO
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
HMO
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
Medicaid
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
Medicare Part A
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
Medicare Part B
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
POS
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
PPO
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70360
null
cpt
X-ray of soft tissue of neck
tricare
Workers Comp
O
213.69
61.44
71.65
71.65
71.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
EPO
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
HMO
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
Medicaid
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
Medicare Part A
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
Medicare Part B
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
POS
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
PPO
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna
Workers Comp
O
2313.92
96.51
1300.21
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
EPO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
HMO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
Medicaid
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
Medicare Part A
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
Medicare Part B
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
POS
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
PPO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
aetna - medicare advantage
Workers Comp
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
EPO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
HMO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
Medicaid
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
Medicare Part A
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
Medicare Part B
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
POS
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
PPO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield
Workers Comp
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
EPO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
HMO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
Medicaid
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
POS
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
PPO
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2313.92
96.51
228.66
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
EPO
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
HMO
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
Medicaid
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
Medicare Part A
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
Medicare Part B
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
POS
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
PPO
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
humana - medicare advantage
Workers Comp
O
2313.92
96.51
96.51
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
EPO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
HMO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
Medicaid
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
Medicare Part A
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
Medicare Part B
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
POS
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
PPO
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
tricare
Workers Comp
O
2313.92
96.51
99.29
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
EPO
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
HMO
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
Medicaid
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
Medicare Part A
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
Medicare Part B
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
POS
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
PPO
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare
Workers Comp
O
2313.92
96.51
1735.44
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
EPO
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
HMO
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
Medicaid
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
Medicare Part A
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
Medicare Part B
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
POS
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
PPO
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70450
null
cpt
CT of Head without contrast
united healthcare - medicare advantage
Workers Comp
O
2313.92
96.51
97.90
1735.44
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
EPO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
HMO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
Medicaid
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
Medicare Part A
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
Medicare Part B
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
POS
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
PPO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield
Workers Comp
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
EPO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
HMO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
POS
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
PPO
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2410.75
158.13
202.04
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
EPO
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
HMO
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
Medicaid
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
Medicare Part A
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
Medicare Part B
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
POS
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
PPO
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70470
null
cpt
CT scan head or brain before and after contrast
humana - medicare advantage
Workers Comp
O
2410.75
158.13
158.13
202.04
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
EPO
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
HMO
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
Medicaid
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
Medicare Part A
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
Medicare Part B
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
POS
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
PPO
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
aetna
Workers Comp
O
1195.36
96.50
671.68
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
EPO
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
HMO
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
Medicaid
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
Medicare Part A
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
Medicare Part B
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
POS
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
PPO
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
blue cross blue shield
Workers Comp
O
1195.36
96.50
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
EPO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
HMO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
Medicaid
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
Medicare Part A
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
Medicare Part B
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
POS
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
PPO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
humana - medicare advantage
Workers Comp
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
EPO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
HMO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
Medicaid
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
Medicare Part A
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
Medicare Part B
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
POS
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
PPO
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
tricare
Workers Comp
O
1195.36
96.50
99.29
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
EPO
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
HMO
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
Medicaid
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
Medicare Part A
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
Medicare Part B
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
POS
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
PPO
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
va
Workers Comp
O
1195.36
96.50
96.50
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
EPO
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
HMO
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
Medicaid
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
Medicare Part A
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
Medicare Part B
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
POS
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
PPO
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70480
null
cpt
CT scan of cranial cavity
webtpa
Workers Comp
O
1195.36
96.50
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
EPO
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
HMO
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
Medicaid
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
Medicare Part A
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
Medicare Part B
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
POS
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
PPO
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70482
null
cpt
CT scan of cranial cavity before and after contrast
blue cross blue shield
Workers Comp
O
1879.85
406.99
406.99
406.99
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
EPO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
HMO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
Medicaid
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
Medicare Part A
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
Medicare Part B
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
POS
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
PPO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield
Workers Comp
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
EPO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
HMO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
Medicaid
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
Medicare Part A
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
Medicare Part B
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
POS
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
PPO
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
blue cross blue shield - medicare advantage
Workers Comp
O
1195.36
95.28
482.16
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
EPO
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
HMO
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
Medicaid
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
Medicare Part A
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
Medicare Part B
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
POS
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
PPO
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
humana - medicare advantage
Workers Comp
O
1195.36
95.28
99.29
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
EPO
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
HMO
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
Medicaid
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
Medicare Part A
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
Medicare Part B
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
POS
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
PPO
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
tricare
Workers Comp
O
1195.36
95.28
96.51
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
EPO
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
HMO
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
Medicaid
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
Medicare Part A
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
Medicare Part B
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
POS
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
PPO
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
united healthcare
Workers Comp
O
1195.36
95.28
896.52
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
EPO
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
HMO
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
Medicaid
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
Medicare Part A
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
Medicare Part B
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
POS
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
PPO
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
va
Workers Comp
O
1195.36
95.28
95.28
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
EPO
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
HMO
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
Medicaid
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
Medicare Part A
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
Medicare Part B
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
POS
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
PPO
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70486
null
cpt
CT scan of face
webtpa
Workers Comp
O
1195.36
95.28
796.91
896.52
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
EPO
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
HMO
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
Medicaid
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
Medicare Part A
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
Medicare Part B
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
POS
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
PPO
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70488
null
cpt
CT scan of face before and after contrast
humana - medicare advantage
Workers Comp
O
1879.85
158.13
158.13
158.13
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
EPO
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
HMO
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
Medicaid
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
Medicare Part A
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
Medicare Part B
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
POS
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
PPO
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna
Workers Comp
O
1195.36
96.51
693.31
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
EPO
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
HMO
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
Medicaid
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
Medicare Part A
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
Medicare Part B
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
POS
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
PPO
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
aetna - medicare advantage
Workers Comp
O
1195.36
96.51
214.42
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
EPO
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
HMO
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
Medicaid
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
Medicare Part A
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
Medicare Part B
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
POS
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
PPO
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
blue cross blue shield
Workers Comp
O
1195.36
96.51
739.76
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
EPO
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
HMO
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
Medicaid
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
Medicare Part A
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
Medicare Part B
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
POS
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
PPO
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
humana - medicare advantage
Workers Comp
O
1195.36
96.51
155.47
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
EPO
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
HMO
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
Medicaid
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
Medicare Part A
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
Medicare Part B
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
POS
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
PPO
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70490
null
cpt
CT scan of neck
tricare
Workers Comp
O
1195.36
96.51
96.51
739.76
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
EPO
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
HMO
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
Medicaid
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
Medicare Part A
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
Medicare Part B
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
POS
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
PPO
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna
Workers Comp
O
1318.90
158.13
741.10
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
EPO
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
HMO
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
Medicaid
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
Medicare Part A
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
Medicare Part B
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
POS
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
PPO
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
aetna - medicare advantage
Workers Comp
O
1318.90
158.13
170.49
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
EPO
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
HMO
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
Medicaid
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
Medicare Part A
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
Medicare Part B
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
POS
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
PPO
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield
Workers Comp
O
1318.90
158.13
382.93
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
EPO
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
HMO
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
POS
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
PPO
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1318.90
158.13
380.22
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
EPO
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
HMO
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
Medicaid
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
Medicare Part A
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
Medicare Part B
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
POS
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
PPO
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
humana - medicare advantage
Workers Comp
O
1318.90
158.13
161.43
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
EPO
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
HMO
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
Medicaid
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
Medicare Part A
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
Medicare Part B
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
POS
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
PPO
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
tricare
Workers Comp
O
1318.90
158.13
385.37
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
EPO
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
HMO
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
Medicaid
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
Medicare Part A
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
Medicare Part B
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
POS
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
PPO
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70491
null
cpt
CT scan of neck with contrast
va
Workers Comp
O
1318.90
158.13
158.13
741.10
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
EPO
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
HMO
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
Medicaid
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
Medicare Part A
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
Medicare Part B
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
POS
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
PPO
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
blue cross blue shield
Workers Comp
O
1790.34
159.78
922.62
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
EPO
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
HMO
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
Medicaid
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
Medicare Part A
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
Medicare Part B
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
POS
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
PPO
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
humana - medicare advantage
Workers Comp
O
1790.34
159.78
159.78
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
EPO
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
HMO
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
Medicaid
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
Medicare Part A
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
Medicare Part B
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
POS
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
PPO
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70492
null
cpt
CT scan of neck before and after contrast
tricare
Workers Comp
O
1790.34
159.78
167.70
922.62
1074.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
EPO
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
HMO
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
Medicaid
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
Medicare Part A
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
Medicare Part B
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
POS
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
PPO
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70498
null
cpt
CT scan of neck blood vessels with contrast
humana - medicare advantage
Workers Comp
O
1737.39
161.43
161.43
161.43
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
EPO
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
HMO
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
Medicaid
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
Medicare Part A
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
Medicare Part B
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
POS
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
PPO
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield
Workers Comp
O
1663.93
1017.53
1138.21
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
EPO
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
HMO
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
Medicaid
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
Medicare Part A
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
Medicare Part B
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
POS
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
PPO
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70540
null
cpt
MRI scan bones of the eye face and/or neck
blue cross blue shield - medicare advantage
Workers Comp
O
1663.93
1017.53
1017.53
1138.21
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
EPO
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
HMO
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
Medicaid
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
Medicare Part A
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
Medicare Part B
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
POS
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
PPO
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
blue cross blue shield
Workers Comp
O
1991.15
326.01
867.17
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
EPO
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
HMO
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
Medicaid
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
Medicare Part A
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
Medicare Part B
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
POS
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
PPO
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
humana - medicare advantage
Workers Comp
O
1991.15
326.01
332.15
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
EPO
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
HMO
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
Medicaid
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
Medicare Part A
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
Medicare Part B
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
POS
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
PPO
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
tricare
Workers Comp
O
1991.15
326.01
338.27
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
EPO
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
HMO
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
Medicaid
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
Medicare Part A
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
Medicare Part B
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
POS
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
PPO
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70543
null
cpt
MRI scan bones of the eye face and/or neck before and after contrast
va
Workers Comp
O
1991.15
326.01
326.01
867.17
1194.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
EPO
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
HMO
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
Medicaid
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
Medicare Part A
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
Medicare Part B
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
POS
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
PPO
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70544
null
cpt
MRA scan of head blood vessels
humana - medicare advantage
Workers Comp
O
2677.87
463.00
463.00
463.00
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
EPO
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
HMO
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
Medicaid
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
Medicare Part A
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
Medicare Part B
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
POS
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
PPO
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70547
null
cpt
MRA scan of neck blood vessels
blue cross blue shield - medicare advantage
Workers Comp
O
2677.87
715.80
715.80
715.80
1606.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
EPO
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
HMO
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
Medicaid
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
Medicare Part A
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
Medicare Part B
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
POS
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
PPO
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna
Workers Comp
O
2719.05
203.81
1577.05
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
EPO
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
HMO
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
Medicaid
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
POS
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
PPO
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
205.07
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
EPO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
HMO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
Medicaid
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
Medicare Part A
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
Medicare Part B
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
POS
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
PPO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield
Workers Comp
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
811.86
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
EPO
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
HMO
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
Medicaid
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
Medicare Part A
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
Medicare Part B
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
POS
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
PPO
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
cigna
Workers Comp
O
2719.05
203.81
1924.06
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
EPO
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
HMO
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
Medicaid
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
Medicare Part A
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
Medicare Part B
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
POS
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
PPO
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
healthchoice
Workers Comp
O
2719.05
203.81
1054.02
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
EPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
HMO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
Medicaid
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
POS
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
PPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
humana - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
EPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
HMO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
Medicaid
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
Medicare Part A
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
Medicare Part B
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
POS
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
PPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
tricare
Workers Comp
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
EPO
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
HMO
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
Medicaid
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
Medicare Part A
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
Medicare Part B
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
POS
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
PPO
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
united healthcare
Workers Comp
O
2719.05
203.81
1990.74
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
EPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
HMO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
Medicaid
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
Medicare Part A
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
Medicare Part B
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
POS
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
PPO
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
va
Workers Comp
O
2719.05
203.81
203.81
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
EPO
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
HMO
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
Medicaid
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
Medicare Part A
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
Medicare Part B
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
POS
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
PPO
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70551
null
cpt
MRI scan brain
webtpa
Workers Comp
O
2719.05
203.81
1812.71
1990.74
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
EPO
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
HMO
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
Medicaid
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
Medicare Part A
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
Medicare Part B
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
POS
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
PPO
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna
Workers Comp
O
3608.34
25.27
2136.50
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
EPO
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
HMO
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
Medicaid
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
Medicare Part A
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
Medicare Part B
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
POS
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
PPO
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
aetna - medicare advantage
Workers Comp
O
3608.34
25.27
332.15
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
EPO
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
HMO
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
Medicaid
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
Medicare Part A
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
Medicare Part B
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
POS
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
PPO
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield
Workers Comp
O
3608.34
25.27
751.62
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
EPO
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
HMO
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
POS
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
PPO
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
3608.34
25.27
740.95
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
EPO
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
HMO
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
Medicaid
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
Medicare Part A
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
Medicare Part B
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
POS
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
PPO
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
healthchoice
Workers Comp
O
3608.34
25.27
25.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
EPO
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
HMO
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
Medicaid
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
Medicare Part A
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
Medicare Part B
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
POS
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
PPO
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
humana - medicare advantage
Workers Comp
O
3608.34
25.27
334.00
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
EPO
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
HMO
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
Medicaid
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
Medicare Part A
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
Medicare Part B
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
POS
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
PPO
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
tricare
Workers Comp
O
3608.34
25.27
338.27
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
EPO
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
HMO
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
Medicaid
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
Medicare Part A
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
Medicare Part B
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
POS
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
PPO
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare
Workers Comp
O
3608.34
25.27
2577.39
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
EPO
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
HMO
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
Medicaid
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
Medicare Part A
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
Medicare Part B
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
POS
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
PPO
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
united healthcare - medicare advantage
Workers Comp
O
3608.34
25.27
326.12
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
EPO
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
HMO
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
Medicaid
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
Medicare Part A
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
Medicare Part B
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
POS
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
PPO
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
70553
null
cpt
MRI of brain before and after contrast
va
Workers Comp
O
3608.34
25.27
326.01
2577.39
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
EPO
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
HMO
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
Medicaid
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
Medicare Part A
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
Medicare Part B
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
POS
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
PPO
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield
Workers Comp
I
49212.13
10567.77
17233.48
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
EPO
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
HMO
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
POS
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
PPO
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
49212.13
10567.77
13215.80
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
EPO
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
HMO
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
Medicaid
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
Medicare Part A
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
Medicare Part B
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
POS
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
PPO
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
humana - medicare advantage
Workers Comp
I
49212.13
10567.77
10567.77
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
EPO
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
HMO
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
Medicaid
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
Medicare Part A
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
Medicare Part B
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
POS
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
PPO
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
707
null
ms-drg
major male pelvic procedures with cc/mcc
tricare
Workers Comp
I
49212.13
10567.77
16265.15
17233.48
29527.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
EPO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
HMO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
Medicaid
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
Medicare Part A
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
Medicare Part B
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
POS
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
PPO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
aetna
Workers Comp
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
EPO
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
HMO
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
Medicaid
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
Medicare Part A
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
Medicare Part B
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
POS
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
PPO
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield
Workers Comp
O
212.58
46.81
46.81
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
EPO
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
HMO
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
Medicaid
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
Medicare Part A
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
Medicare Part B
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
POS
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
PPO
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
blue cross blue shield - medicare advantage
Workers Comp
O
212.58
46.81
85.58
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
EPO
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
HMO
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
Medicaid
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
Medicare Part A
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
Medicare Part B
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
POS
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
PPO
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
humana - medicare advantage
Workers Comp
O
212.58
46.81
71.65
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
EPO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
HMO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
Medicaid
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
Medicare Part A
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
Medicare Part B
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
POS
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
PPO
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
tricare
Workers Comp
O
212.58
46.81
70.70
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
EPO
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
HMO
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
Medicaid
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
Medicare Part A
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
Medicare Part B
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
POS
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
PPO
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
united healthcare
Workers Comp
O
212.58
46.81
159.44
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
EPO
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
HMO
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
Medicaid
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
Medicare Part A
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
Medicare Part B
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
POS
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
PPO
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71045
null
cpt
X-ray of chest 1 view
va
Workers Comp
O
212.58
46.81
69.82
159.44
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
EPO
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
HMO
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
Medicaid
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
Medicare Part A
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
Medicare Part B
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
POS
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
PPO
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna
Workers Comp
O
324.99
3.64
188.49
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
EPO
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
HMO
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
Medicaid
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
Medicare Part A
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
Medicare Part B
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
POS
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
PPO
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
aetna - medicare advantage
Workers Comp
O
324.99
3.64
71.18
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
EPO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
HMO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
Medicaid
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
Medicare Part A
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
Medicare Part B
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
POS
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
PPO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield
Workers Comp
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
EPO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
HMO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
Medicaid
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
POS
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
PPO
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
324.99
3.64
61.44
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
EPO
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
HMO
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
Medicaid
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
Medicare Part A
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
Medicare Part B
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
POS
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
PPO
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
cigna
Workers Comp
O
324.99
3.64
216.97
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
EPO
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
HMO
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
Medicaid
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
Medicare Part A
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
Medicare Part B
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
POS
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
PPO
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
healthchoice
Workers Comp
O
324.99
3.64
3.64
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
EPO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
HMO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
Medicaid
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
Medicare Part A
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
Medicare Part B
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
POS
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
PPO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
humana - medicare advantage
Workers Comp
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
EPO
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
HMO
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
Medicaid
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
Medicare Part A
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
Medicare Part B
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
POS
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
PPO
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
medica
Workers Comp
O
324.99
3.64
120.25
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
EPO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
HMO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
Medicaid
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
Medicare Part A
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
Medicare Part B
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
POS
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
PPO
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
tricare
Workers Comp
O
324.99
3.64
70.70
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
EPO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
HMO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
Medicaid
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
Medicare Part A
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
Medicare Part B
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
POS
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
PPO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare
Workers Comp
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
EPO
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
HMO
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
Medicaid
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
Medicare Part A
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
Medicare Part B
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
POS
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
PPO
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
united healthcare - medicare advantage
Workers Comp
O
324.99
3.64
69.69
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
EPO
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
HMO
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
Medicaid
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
Medicare Part A
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
Medicare Part B
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
POS
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
PPO
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
va
Workers Comp
O
324.99
3.64
71.65
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
EPO
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
HMO
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
Medicaid
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
Medicare Part A
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
Medicare Part B
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
POS
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
PPO
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
webtpa
Workers Comp
O
324.99
3.64
216.66
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
EPO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
HMO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
Medicaid
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
Medicare Part A
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
Medicare Part B
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
POS
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
PPO
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71046
null
cpt
X-ray of chest 2 views
worker comp
Workers Comp
O
324.99
3.64
232.14
232.14
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
EPO
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
HMO
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
Medicaid
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
Medicare Part A
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
Medicare Part B
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
POS
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
PPO
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
aetna
Workers Comp
O
418.48
61.44
235.15
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
EPO
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
HMO
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
Medicaid
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
Medicare Part A
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
Medicare Part B
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
POS
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
PPO
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
blue cross blue shield
Workers Comp
O
418.48
61.44
61.44
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
EPO
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
HMO
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
Medicaid
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
Medicare Part A
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
Medicare Part B
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
POS
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
PPO
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71048
null
cpt
X-ray of chest minimum of 4 views
humana - medicare advantage
Workers Comp
O
418.48
61.44
96.51
235.15
251.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
EPO
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
HMO
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
Medicaid
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
Medicare Part A
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
Medicare Part B
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
POS
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
PPO
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
aetna
Workers Comp
O
379.53
54.32
213.26
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
EPO
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
HMO
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
Medicaid
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
Medicare Part A
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
Medicare Part B
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
POS
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
PPO
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield
Workers Comp
O
379.53
54.32
54.32
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
EPO
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
HMO
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
Medicaid
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
POS
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
PPO
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
379.53
54.32
128.84
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
EPO
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
HMO
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
Medicaid
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
Medicare Part A
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
Medicare Part B
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
POS
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
PPO
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
humana - medicare advantage
Workers Comp
O
379.53
54.32
70.70
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
EPO
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
HMO
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
Medicaid
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
Medicare Part A
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
Medicare Part B
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
POS
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
PPO
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71100
null
cpt
X-ray of ribs of one side of body 2 views
tricare
Workers Comp
O
379.53
54.32
71.65
213.26
227.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
EPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
HMO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
Medicaid
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
Medicare Part A
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
Medicare Part B
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
POS
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
PPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
aetna - medicare advantage
Workers Comp
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
EPO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
HMO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
Medicaid
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
Medicare Part A
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
Medicare Part B
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
POS
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
PPO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield
Workers Comp
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
336.12
57.69
57.69
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
EPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
HMO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
Medicaid
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
Medicare Part A
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
Medicare Part B
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
POS
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
PPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
humana - medicare advantage
Workers Comp
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
EPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
HMO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
Medicaid
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
Medicare Part A
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
Medicare Part B
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
POS
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
PPO
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
tricare
Workers Comp
O
336.12
57.69
96.51
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
EPO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
HMO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
Medicaid
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
Medicare Part A
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
Medicare Part B
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
POS
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
PPO
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
united healthcare
Workers Comp
O
336.12
57.69
61.44
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
EPO
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
HMO
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
Medicaid
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
Medicare Part A
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
Medicare Part B
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
POS
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
PPO
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
va
Workers Comp
O
336.12
57.69
96.50
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
EPO
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
HMO
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
Medicaid
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
Medicare Part A
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
Medicare Part B
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
POS
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
PPO
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71101
null
cpt
X-ray of ribs on one side of body including the chest minimum of 3 views
webtpa
Workers Comp
O
336.12
57.69
224.08
224.08
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
EPO
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
HMO
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
Medicaid
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
Medicare Part A
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
Medicare Part B
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
POS
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
PPO
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield
Workers Comp
O
450.76
35.49
45.55
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
EPO
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
HMO
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
Medicaid
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
POS
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
PPO
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71110
null
cpt
X-ray of both sides of the ribs 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
450.76
35.49
35.49
45.55
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
EPO
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
HMO
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
Medicaid
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
Medicare Part A
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
Medicare Part B
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
POS
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
PPO
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
aetna - medicare advantage
Workers Comp
O
336.12
61.44
96.51
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
EPO
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
HMO
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
Medicaid
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
Medicare Part A
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
Medicare Part B
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
POS
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
PPO
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
blue cross blue shield
Workers Comp
O
336.12
61.44
61.44
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
EPO
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
HMO
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
Medicaid
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
Medicare Part A
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
Medicare Part B
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
POS
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
PPO
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71111
null
cpt
X-ray of both sides of the ribs including the chest minimum of 4 views
humana - medicare advantage
Workers Comp
O
336.12
61.44
99.29
99.29
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
EPO
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
HMO
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
Medicaid
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
Medicare Part A
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
Medicare Part B
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
POS
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
PPO
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71120
null
cpt
X-ray of breast bone minimum of 2 views
blue cross blue shield
Workers Comp
O
207.76
119.99
119.99
119.99
124.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
EPO
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
HMO
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
Medicaid
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
Medicare Part A
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
Medicare Part B
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
POS
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
PPO
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
aetna - medicare advantage
Workers Comp
O
1560.42
97.40
97.40
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
EPO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
HMO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
Medicaid
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
Medicare Part A
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
Medicare Part B
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
POS
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
PPO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield
Workers Comp
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
EPO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
HMO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
Medicaid
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
Medicare Part A
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
Medicare Part B
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
POS
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
PPO
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
blue cross blue shield - medicare advantage
Workers Comp
O
1560.42
97.40
482.16
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
EPO
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
HMO
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
Medicaid
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
Medicare Part A
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
Medicare Part B
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
POS
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
PPO
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
humana - medicare advantage
Workers Comp
O
1560.42
97.40
97.90
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
EPO
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
HMO
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
Medicaid
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
Medicare Part A
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
Medicare Part B
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
POS
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
PPO
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
tricare
Workers Comp
O
1560.42
97.40
99.29
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
EPO
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
HMO
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
Medicaid
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
Medicare Part A
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
Medicare Part B
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
POS
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
PPO
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71250
null
cpt
CT scan chest
webtpa
Workers Comp
O
1560.42
97.40
1040.28
1040.28
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
EPO
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
HMO
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
Medicaid
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
Medicare Part A
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
Medicare Part B
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
POS
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
PPO
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna
Workers Comp
O
1673.95
44.35
955.75
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
EPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
HMO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
Medicaid
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
Medicare Part A
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
Medicare Part B
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
POS
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
PPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
aetna - medicare advantage
Workers Comp
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
EPO
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
HMO
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
Medicaid
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
Medicare Part A
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
Medicare Part B
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
POS
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
PPO
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield
Workers Comp
O
1673.95
44.35
358.87
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
EPO
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
HMO
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
POS
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
PPO
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1673.95
44.35
396.84
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
EPO
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
HMO
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
Medicaid
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
Medicare Part A
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
Medicare Part B
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
POS
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
PPO
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
cigna
Workers Comp
O
1673.95
44.35
1117.56
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
EPO
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
HMO
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
Medicaid
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
Medicare Part A
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
Medicare Part B
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
POS
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
PPO
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
healthchoice
Workers Comp
O
1673.95
44.35
44.35
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
EPO
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
HMO
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
Medicaid
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
Medicare Part A
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
Medicare Part B
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
POS
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
PPO
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
humana - medicare advantage
Workers Comp
O
1673.95
44.35
160.14
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
EPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
HMO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
Medicaid
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
Medicare Part A
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
Medicare Part B
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
POS
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
PPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
tricare
Workers Comp
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
EPO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
HMO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
Medicaid
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
Medicare Part A
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
Medicare Part B
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
POS
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
PPO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare
Workers Comp
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
EPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
HMO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
Medicaid
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
Medicare Part A
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
Medicare Part B
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
POS
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
PPO
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
united healthcare - medicare advantage
Workers Comp
O
1673.95
44.35
161.43
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
EPO
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
HMO
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
Medicaid
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
Medicare Part A
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
Medicare Part B
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
POS
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
PPO
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
va
Workers Comp
O
1673.95
44.35
139.45
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
EPO
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
HMO
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
Medicaid
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
Medicare Part A
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
Medicare Part B
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
POS
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
PPO
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
webtpa
Workers Comp
O
1673.95
44.35
282.96
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
EPO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
HMO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
Medicaid
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
Medicare Part A
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
Medicare Part B
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
POS
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
PPO
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71260
null
cpt
CT scan chest with contrast
worker comp
Workers Comp
O
1673.95
44.35
1195.68
1195.68
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
EPO
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
HMO
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
Medicaid
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
Medicare Part A
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
Medicare Part B
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
POS
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
PPO
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield
Workers Comp
O
2294.90
161.43
808.13
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
EPO
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
HMO
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
POS
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
PPO
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2294.90
161.43
846.57
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
EPO
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
HMO
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
Medicaid
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
Medicare Part A
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
Medicare Part B
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
POS
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
PPO
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71270
null
cpt
CT scan chest before and after contrast
humana - medicare advantage
Workers Comp
O
2294.90
161.43
161.43
846.57
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
EPO
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
HMO
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
Medicaid
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
Medicare Part A
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
Medicare Part B
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
POS
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
PPO
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna
Workers Comp
O
1594.24
158.13
970.89
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
EPO
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
HMO
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
Medicaid
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
Medicare Part A
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
Medicare Part B
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
POS
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
PPO
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
aetna - medicare advantage
Workers Comp
O
1594.24
158.13
164.40
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
EPO
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
HMO
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
Medicaid
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
Medicare Part A
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
Medicare Part B
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
POS
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
PPO
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield
Workers Comp
O
1594.24
158.13
1066.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
EPO
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
HMO
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
POS
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
PPO
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1594.24
158.13
872.23
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
EPO
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
HMO
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
Medicaid
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
Medicare Part A
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
Medicare Part B
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
POS
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
PPO
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
humana - medicare advantage
Workers Comp
O
1594.24
158.13
161.43
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
EPO
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
HMO
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
Medicaid
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
Medicare Part A
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
Medicare Part B
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
POS
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
PPO
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
tricare
Workers Comp
O
1594.24
158.13
158.13
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
EPO
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
HMO
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
Medicaid
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
Medicare Part A
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
Medicare Part B
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
POS
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
PPO
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
united healthcare
Workers Comp
O
1594.24
158.13
1195.68
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
EPO
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
HMO
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
Medicaid
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
Medicare Part A
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
Medicare Part B
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
POS
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
PPO
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
71275
null
cpt
CT scan of blood vessels in chest with contrast
va
Workers Comp
O
1594.24
158.13
179.87
1195.68
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
EPO
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
HMO
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
Medicaid
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
Medicare Part A
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
Medicare Part B
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
POS
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
PPO
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
blue cross blue shield
Workers Comp
O
213.69
89.06
89.06
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
EPO
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
HMO
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
Medicaid
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
Medicare Part A
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
Medicare Part B
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
POS
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
PPO
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72020
null
cpt
X-ray of spine 1 view
va
Workers Comp
O
213.69
89.06
213.69
213.69
58.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
EPO
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
HMO
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
Medicaid
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
Medicare Part A
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
Medicare Part B
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
POS
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
PPO
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
aetna
Workers Comp
O
322.77
44.00
181.37
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
EPO
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
HMO
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
Medicaid
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
Medicare Part A
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
Medicare Part B
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
POS
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
PPO
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield
Workers Comp
O
322.77
44.00
61.44
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
EPO
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
HMO
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
Medicaid
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
POS
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
PPO
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
322.77
44.00
44.00
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
EPO
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
HMO
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
Medicaid
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
Medicare Part A
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
Medicare Part B
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
POS
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
PPO
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
humana - medicare advantage
Workers Comp
O
322.77
44.00
71.65
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
EPO
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
HMO
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
Medicaid
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
Medicare Part A
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
Medicare Part B
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
POS
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
PPO
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
medica
Workers Comp
O
322.77
44.00
119.42
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
EPO
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
HMO
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
Medicaid
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
Medicare Part A
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
Medicare Part B
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
POS
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
PPO
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
tricare
Workers Comp
O
322.77
44.00
70.70
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
EPO
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
HMO
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
Medicaid
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
Medicare Part A
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
Medicare Part B
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
POS
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
PPO
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72040
null
cpt
X-ray of spine of neck 2 or 3 views
united healthcare
Workers Comp
O
322.77
44.00
230.55
230.55
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
EPO
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
HMO
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
Medicaid
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
Medicare Part A
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
Medicare Part B
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
POS
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
PPO
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna
Workers Comp
O
578.76
31.17
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
EPO
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
HMO
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
Medicaid
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
Medicare Part A
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
Medicare Part B
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
POS
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
PPO
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
aetna - medicare advantage
Workers Comp
O
578.76
31.17
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
EPO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
HMO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
Medicaid
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
Medicare Part A
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
Medicare Part B
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
POS
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
PPO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield
Workers Comp
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
EPO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
HMO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
Medicaid
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
Medicare Part A
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
Medicare Part B
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
POS
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
PPO
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
blue cross blue shield - medicare advantage
Workers Comp
O
578.76
31.17
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
EPO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
HMO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
Medicaid
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
Medicare Part A
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
Medicare Part B
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
POS
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
PPO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
humana - medicare advantage
Workers Comp
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
EPO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
HMO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
Medicaid
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
Medicare Part A
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
Medicare Part B
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
POS
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
PPO
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
tricare
Workers Comp
O
578.76
31.17
99.29
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
EPO
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
HMO
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
Medicaid
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
Medicare Part A
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
Medicare Part B
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
POS
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
PPO
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
united healthcare
Workers Comp
O
578.76
31.17
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
EPO
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
HMO
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
Medicaid
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
Medicare Part A
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
Medicare Part B
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
POS
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
PPO
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
va
Workers Comp
O
578.76
31.17
31.17
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
EPO
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
HMO
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
Medicaid
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
Medicare Part A
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
Medicare Part B
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
POS
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
PPO
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
webtpa
Workers Comp
O
578.76
31.17
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
EPO
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
HMO
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
Medicaid
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
Medicare Part A
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
Medicare Part B
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
POS
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
PPO
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72050
null
cpt
X-ray of upper spine 4 or 5 views
worker comp
Workers Comp
O
578.76
31.17
42.39
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
EPO
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
HMO
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
Medicaid
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
Medicare Part A
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
Medicare Part B
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
POS
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
PPO
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield
Workers Comp
O
554.27
86.13
86.13
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
EPO
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
HMO
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
Medicaid
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
Medicare Part A
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
Medicare Part B
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
POS
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
PPO
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
blue cross blue shield - medicare advantage
Workers Comp
O
554.27
86.13
99.36
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
EPO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
HMO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
Medicaid
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
Medicare Part A
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
Medicare Part B
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
POS
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
PPO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
humana - medicare advantage
Workers Comp
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
EPO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
HMO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
Medicaid
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
Medicare Part A
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
Medicare Part B
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
POS
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
PPO
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
tricare
Workers Comp
O
554.27
86.13
99.29
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
EPO
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
HMO
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
Medicaid
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
Medicare Part A
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
Medicare Part B
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
POS
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
PPO
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
united healthcare
Workers Comp
O
554.27
86.13
415.70
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
EPO
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
HMO
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
Medicaid
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
Medicare Part A
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
Medicare Part B
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
POS
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
PPO
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72052
null
cpt
X-ray of upper spine 6 or more views
webtpa
Workers Comp
O
554.27
86.13
387.99
415.70
332.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
EPO
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
HMO
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
Medicaid
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
Medicare Part A
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
Medicare Part B
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
POS
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
PPO
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
blue cross blue shield
Workers Comp
O
287.15
32.63
32.63
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
EPO
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
HMO
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
Medicaid
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
Medicare Part A
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
Medicare Part B
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
POS
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
PPO
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
humana - medicare advantage
Workers Comp
O
287.15
32.63
99.29
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
EPO
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
HMO
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
Medicaid
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
Medicare Part A
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
Medicare Part B
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
POS
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
PPO
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72070
null
cpt
X-ray of middle spine 2 views
medica
Workers Comp
O
287.15
32.63
106.25
106.25
172.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
EPO
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
HMO
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
Medicaid
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
Medicare Part A
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
Medicare Part B
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
POS
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
PPO
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
aetna
Workers Comp
O
336.12
23.98
191.91
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
EPO
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
HMO
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
Medicaid
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
Medicare Part A
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
Medicare Part B
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
POS
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
PPO
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield
Workers Comp
O
336.12
23.98
58.07
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
EPO
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
HMO
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
Medicaid
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
POS
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
PPO
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
336.12
23.98
61.44
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
EPO
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
HMO
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
Medicaid
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
Medicare Part A
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
Medicare Part B
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
POS
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
PPO
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
humana - medicare advantage
Workers Comp
O
336.12
23.98
96.51
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
EPO
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
HMO
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
Medicaid
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
Medicare Part A
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
Medicare Part B
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
POS
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
PPO
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
tricare
Workers Comp
O
336.12
23.98
97.90
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
EPO
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
HMO
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
Medicaid
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
Medicare Part A
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
Medicare Part B
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
POS
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
PPO
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
va
Workers Comp
O
336.12
23.98
23.98
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
EPO
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
HMO
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
Medicaid
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
Medicare Part A
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
Medicare Part B
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
POS
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
PPO
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
webtpa
Workers Comp
O
336.12
23.98
224.08
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
EPO
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
HMO
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
Medicaid
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
Medicare Part A
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
Medicare Part B
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
POS
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
PPO
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72072
null
cpt
X-ray of middle spine 3 views
worker comp
Workers Comp
O
336.12
23.98
240.09
240.09
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
EPO
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
HMO
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
Medicaid
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
Medicare Part A
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
Medicare Part B
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
POS
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
PPO
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
aetna
Workers Comp
O
237.06
20.26
133.21
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
EPO
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
HMO
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
Medicaid
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
Medicare Part A
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
Medicare Part B
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
POS
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
PPO
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield
Workers Comp
O
237.06
20.26
61.44
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
EPO
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
HMO
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
Medicaid
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
POS
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
PPO
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
237.06
20.26
29.85
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
EPO
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
HMO
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
Medicaid
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
Medicare Part A
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
Medicare Part B
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
POS
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
PPO
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
humana - medicare advantage
Workers Comp
O
237.06
20.26
70.70
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
EPO
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
HMO
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
Medicaid
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
Medicare Part A
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
Medicare Part B
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
POS
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
PPO
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
united healthcare
Workers Comp
O
237.06
20.26
173.57
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
EPO
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
HMO
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
Medicaid
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
Medicare Part A
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
Medicare Part B
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
POS
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
PPO
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72080
null
cpt
X-ray of middle and lower spine 2 views
va
Workers Comp
O
237.06
20.26
20.26
173.57
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
EPO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
HMO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
Medicaid
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
Medicare Part A
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
Medicare Part B
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
POS
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
PPO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
aetna - medicare advantage
Workers Comp
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
EPO
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
HMO
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
Medicaid
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
Medicare Part A
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
Medicare Part B
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
POS
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
PPO
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield
Workers Comp
O
201.45
60.79
61.44
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
EPO
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
HMO
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
Medicaid
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
Medicare Part A
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
Medicare Part B
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
POS
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
PPO
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
blue cross blue shield - medicare advantage
Workers Comp
O
201.45
60.79
60.79
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
EPO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
HMO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
Medicaid
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
Medicare Part A
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
Medicare Part B
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
POS
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
PPO
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
humana - medicare advantage
Workers Comp
O
201.45
60.79
71.65
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
EPO
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
HMO
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
Medicaid
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
Medicare Part A
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
Medicare Part B
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
POS
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
PPO
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72081
null
cpt
X-ray of spine entire middle and lower spine 1 view
tricare
Workers Comp
O
201.45
60.79
70.70
71.65
84.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
EPO
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
HMO
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
Medicaid
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
Medicare Part A
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
Medicare Part B
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
POS
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
PPO
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
aetna
Workers Comp
O
366.17
61.44
205.76
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
EPO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
HMO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
Medicaid
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
Medicare Part A
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
Medicare Part B
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
POS
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
PPO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield
Workers Comp
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
EPO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
HMO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
Medicaid
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
POS
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
PPO
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
366.17
61.44
61.44
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
EPO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
HMO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
Medicaid
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
Medicare Part A
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
Medicare Part B
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
POS
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
PPO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
humana - medicare advantage
Workers Comp
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
EPO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
HMO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
Medicaid
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
Medicare Part A
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
Medicare Part B
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
POS
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
PPO
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
tricare
Workers Comp
O
366.17
61.44
99.29
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
EPO
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
HMO
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
Medicaid
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
Medicare Part A
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
Medicare Part B
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
POS
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
PPO
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
united healthcare
Workers Comp
O
366.17
61.44
268.09
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
EPO
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
HMO
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
Medicaid
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
Medicare Part A
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
Medicare Part B
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
POS
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
PPO
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72100
null
cpt
X-ray of lower and sacral spine 2 or 3 views
webtpa
Workers Comp
O
366.17
61.44
244.12
268.09
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
EPO
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
HMO
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
Medicaid
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
Medicare Part A
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
Medicare Part B
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
POS
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
PPO
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna
Workers Comp
O
578.76
31.65
335.68
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
EPO
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
HMO
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
Medicaid
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
Medicare Part A
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
Medicare Part B
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
POS
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
PPO
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
aetna - medicare advantage
Workers Comp
O
578.76
31.65
97.24
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
EPO
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
HMO
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
Medicaid
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
Medicare Part A
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
Medicare Part B
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
POS
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
PPO
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield
Workers Comp
O
578.76
31.65
63.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
EPO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
HMO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
Medicaid
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
Medicare Part A
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
Medicare Part B
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
POS
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
PPO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
blue cross blue shield - medicare advantage
Workers Comp
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
EPO
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
HMO
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
Medicaid
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
Medicare Part A
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
Medicare Part B
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
POS
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
PPO
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
healthchoice
Workers Comp
O
578.76
31.65
178.54
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
EPO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
HMO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
Medicaid
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
Medicare Part A
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
Medicare Part B
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
POS
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
PPO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
humana - medicare advantage
Workers Comp
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
EPO
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
HMO
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
Medicaid
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
Medicare Part A
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
Medicare Part B
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
POS
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
PPO
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
medica
Workers Comp
O
578.76
31.65
214.14
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
EPO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
HMO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
Medicaid
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
Medicare Part A
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
Medicare Part B
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
POS
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
PPO
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
tricare
Workers Comp
O
578.76
31.65
96.51
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
EPO
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
HMO
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
Medicaid
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
Medicare Part A
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
Medicare Part B
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
POS
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
PPO
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
united healthcare
Workers Comp
O
578.76
31.65
413.40
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
EPO
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
HMO
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
Medicaid
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
Medicare Part A
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
Medicare Part B
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
POS
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
PPO
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
va
Workers Comp
O
578.76
31.65
31.65
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
EPO
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
HMO
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
Medicaid
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
Medicare Part A
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
Medicare Part B
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
POS
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
PPO
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
webtpa
Workers Comp
O
578.76
31.65
385.84
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
EPO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
HMO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
Medicaid
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
Medicare Part A
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
Medicare Part B
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
POS
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
PPO
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72110
null
cpt
X-Ray of Lower Back 4 views
worker comp
Workers Comp
O
578.76
31.65
61.44
413.40
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
EPO
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
HMO
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
Medicaid
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
Medicare Part A
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
Medicare Part B
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
POS
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
PPO
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
aetna
Workers Comp
O
767.97
8.60
445.42
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
EPO
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
HMO
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
Medicaid
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
Medicare Part A
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
Medicare Part B
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
POS
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
PPO
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield
Workers Comp
O
767.97
8.60
109.39
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
EPO
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
HMO
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
Medicaid
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
Medicare Part A
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
Medicare Part B
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
POS
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
PPO
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
blue cross blue shield - medicare advantage
Workers Comp
O
767.97
8.60
254.23
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
EPO
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
HMO
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
Medicaid
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
Medicare Part A
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
Medicare Part B
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
POS
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
PPO
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
healthchoice
Workers Comp
O
767.97
8.60
8.60
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
EPO
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
HMO
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
Medicaid
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
Medicare Part A
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
Medicare Part B
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
POS
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
PPO
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
humana - medicare advantage
Workers Comp
O
767.97
8.60
96.51
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
EPO
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
HMO
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
Medicaid
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
Medicare Part A
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
Medicare Part B
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
POS
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
PPO
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
tricare
Workers Comp
O
767.97
8.60
99.29
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
EPO
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
HMO
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
Medicaid
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
Medicare Part A
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
Medicare Part B
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
POS
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
PPO
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
united healthcare
Workers Comp
O
767.97
8.60
562.27
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
EPO
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
HMO
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
Medicaid
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
Medicare Part A
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
Medicare Part B
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
POS
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
PPO
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
va
Workers Comp
O
767.97
8.60
92.96
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
EPO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
HMO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
Medicaid
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
Medicare Part A
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
Medicare Part B
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
POS
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
PPO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
webtpa
Workers Comp
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
EPO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
HMO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
Medicaid
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
Medicare Part A
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
Medicare Part B
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
POS
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
PPO
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72114
null
cpt
X-ray lower and sacral spine including bending views minimum 6 views
worker comp
Workers Comp
O
767.97
8.60
537.58
562.27
115.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
EPO
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
HMO
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
Medicaid
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
Medicare Part A
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
Medicare Part B
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
POS
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
PPO
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield
Workers Comp
O
1560.42
99.29
400.81
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
EPO
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
HMO
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
Medicaid
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
Medicare Part A
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
Medicare Part B
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
POS
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
PPO
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
blue cross blue shield - medicare advantage
Workers Comp
O
1560.42
99.29
207.48
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
EPO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
HMO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
Medicaid
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
Medicare Part A
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
Medicare Part B
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
POS
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
PPO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
humana - medicare advantage
Workers Comp
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
EPO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
HMO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
Medicaid
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
Medicare Part A
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
Medicare Part B
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
POS
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
PPO
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
tricare
Workers Comp
O
1560.42
99.29
99.29
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
EPO
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
HMO
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
Medicaid
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
Medicare Part A
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
Medicare Part B
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
POS
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
PPO
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
united healthcare
Workers Comp
O
1560.42
99.29
1170.32
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
EPO
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
HMO
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
Medicaid
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
Medicare Part A
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
Medicare Part B
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
POS
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
PPO
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72125
null
cpt
CT scan of upper spine
va
Workers Comp
O
1560.42
99.29
147.22
1170.32
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
EPO
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
HMO
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
POS
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
PPO
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1672.83
338.27
381.66
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
EPO
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
HMO
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
Medicaid
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
Medicare Part A
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
Medicare Part B
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
POS
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
PPO
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72126
null
cpt
CT scan of upper spine with contrast
tricare
Workers Comp
O
1672.83
338.27
338.27
381.66
1003.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
EPO
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
HMO
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
Medicaid
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
Medicare Part A
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
Medicare Part B
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
POS
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
PPO
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
blue cross blue shield
Workers Comp
O
2410.75
161.43
350.36
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
EPO
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
HMO
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
Medicaid
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
Medicare Part A
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
Medicare Part B
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
POS
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
PPO
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72127
null
cpt
CT scan of upper spine before and after contrast
humana - medicare advantage
Workers Comp
O
2410.75
161.43
161.43
350.36
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
EPO
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
HMO
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
Medicaid
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
Medicare Part A
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
Medicare Part B
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
POS
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
PPO
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
blue cross blue shield
Workers Comp
O
1560.42
96.50
300.68
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
EPO
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
HMO
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
Medicaid
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
Medicare Part A
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
Medicare Part B
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
POS
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
PPO
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
humana - medicare advantage
Workers Comp
O
1560.42
96.50
99.29
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
EPO
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
HMO
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
Medicaid
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
Medicare Part A
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
Medicare Part B
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
POS
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
PPO
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72128
null
cpt
CT scan of middle spine
va
Workers Comp
O
1560.42
96.50
96.50
300.68
936.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
EPO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
HMO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
Medicaid
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
Medicare Part A
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
Medicare Part B
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
POS
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
PPO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield
Workers Comp
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
EPO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
HMO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
Medicaid
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
Medicare Part A
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
Medicare Part B
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
POS
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
PPO
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
blue cross blue shield - medicare advantage
Workers Comp
O
1560.42
96.50
400.81
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
EPO
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
HMO
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
Medicaid
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
Medicare Part A
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
Medicare Part B
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
POS
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
PPO
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
humana - medicare advantage
Workers Comp
O
1560.42
96.50
99.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
EPO
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
HMO
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
Medicaid
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
Medicare Part A
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
Medicare Part B
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
POS
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
PPO
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
tricare
Workers Comp
O
1560.42
96.50
148.99
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
EPO
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
HMO
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
Medicaid
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
Medicare Part A
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
Medicare Part B
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
POS
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
PPO
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
va
Workers Comp
O
1560.42
96.50
96.50
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
EPO
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
HMO
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
Medicaid
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
Medicare Part A
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
Medicare Part B
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
POS
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
PPO
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72131
null
cpt
CT scan of lower spine
webtpa
Workers Comp
O
1560.42
96.50
1066.29
1066.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
EPO
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
HMO
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
Medicaid
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
Medicare Part A
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
Medicare Part B
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
POS
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
PPO
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72133
null
cpt
CT scan of lower spine before and after contrast
humana - medicare advantage
Workers Comp
O
2410.75
158.13
158.13
158.13
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
EPO
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
HMO
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
Medicaid
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
Medicare Part A
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
Medicare Part B
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
POS
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
PPO
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna
Workers Comp
O
2719.05
203.81
1527.85
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
EPO
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
HMO
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
Medicaid
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
POS
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
PPO
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
867.15
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
EPO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
HMO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
Medicaid
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
Medicare Part A
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
Medicare Part B
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
POS
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
PPO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield
Workers Comp
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
EPO
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
HMO
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
Medicaid
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
Medicare Part A
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
Medicare Part B
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
POS
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
PPO
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
healthchoice
Workers Comp
O
2719.05
203.81
443.64
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
humana - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
EPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
HMO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
Medicaid
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
Medicare Part A
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
Medicare Part B
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
POS
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
PPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
tricare
Workers Comp
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
EPO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
HMO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
Medicaid
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
Medicare Part A
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
Medicare Part B
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
POS
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
PPO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
united healthcare
Workers Comp
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
EPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
HMO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
Medicaid
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
Medicare Part A
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
Medicare Part B
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
POS
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
PPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
va
Workers Comp
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
EPO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
HMO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
Medicaid
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
Medicare Part A
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
Medicare Part B
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
POS
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
PPO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72141
null
cpt
MRI scan of upper spinal canal
webtpa
Workers Comp
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
EPO
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
HMO
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
Medicaid
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
Medicare Part A
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
Medicare Part B
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
POS
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
PPO
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna
Workers Comp
O
2719.05
132.00
821.42
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
EPO
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
HMO
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
Medicaid
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
Medicare Part A
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
Medicare Part B
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
POS
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
PPO
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
aetna - medicare advantage
Workers Comp
O
2719.05
132.00
481.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
EPO
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
HMO
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
Medicaid
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
Medicare Part A
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
Medicare Part B
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
POS
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
PPO
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield
Workers Comp
O
2719.05
132.00
343.69
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
EPO
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
HMO
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
POS
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
PPO
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
132.00
458.10
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
EPO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
HMO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
Medicaid
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
Medicare Part A
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
Medicare Part B
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
POS
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
PPO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
humana - medicare advantage
Workers Comp
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
EPO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
HMO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
Medicaid
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
Medicare Part A
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
Medicare Part B
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
POS
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
PPO
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
tricare
Workers Comp
O
2719.05
132.00
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
EPO
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
HMO
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
Medicaid
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
Medicare Part A
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
Medicare Part B
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
POS
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
PPO
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
united healthcare
Workers Comp
O
2719.05
132.00
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
EPO
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
HMO
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
Medicaid
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
Medicare Part A
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
Medicare Part B
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
POS
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
PPO
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
va
Workers Comp
O
2719.05
132.00
132.00
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
EPO
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
HMO
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
Medicaid
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
Medicare Part A
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
Medicare Part B
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
POS
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
PPO
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72146
null
cpt
MRI scan of middle spinal canal
webtpa
Workers Comp
O
2719.05
132.00
1903.34
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
EPO
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
HMO
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
Medicaid
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
Medicare Part A
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
Medicare Part B
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
POS
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
PPO
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna
Workers Comp
O
2719.05
203.81
1527.85
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
EPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
HMO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
Medicaid
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
POS
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
PPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
EPO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
HMO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
Medicaid
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
Medicare Part A
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
Medicare Part B
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
POS
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
PPO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield
Workers Comp
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
458.10
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
EPO
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
HMO
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
Medicaid
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
Medicare Part A
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
Medicare Part B
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
POS
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
PPO
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna
Workers Comp
O
2719.05
203.81
1815.30
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
cigna - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
EPO
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
HMO
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
Medicaid
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
Medicare Part A
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
Medicare Part B
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
POS
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
PPO
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
healthchoice
Workers Comp
O
2719.05
203.81
300.75
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
EPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
HMO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
Medicaid
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
POS
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
PPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
humana - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
EPO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
HMO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
Medicaid
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
Medicare Part A
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
Medicare Part B
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
POS
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
PPO
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
tricare
Workers Comp
O
2719.05
203.81
206.45
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
EPO
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
HMO
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
Medicaid
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
Medicare Part A
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
Medicare Part B
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
POS
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
PPO
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
united healthcare
Workers Comp
O
2719.05
203.81
1942.19
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
EPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
HMO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
Medicaid
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
Medicare Part A
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
Medicare Part B
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
POS
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
PPO
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
va
Workers Comp
O
2719.05
203.81
203.81
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
EPO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
HMO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
Medicaid
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
Medicare Part A
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
Medicare Part B
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
POS
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
PPO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
webtpa
Workers Comp
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
EPO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
HMO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
Medicaid
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
Medicare Part A
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
Medicare Part B
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
POS
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
PPO
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72148
null
cpt
MRI of Lower Spine
worker comp
Workers Comp
O
2719.05
203.81
1812.71
1942.19
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
EPO
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
HMO
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
Medicaid
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
Medicare Part A
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
Medicare Part B
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
POS
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
PPO
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield
Workers Comp
O
3436.52
425.81
425.81
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
EPO
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
HMO
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
POS
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
PPO
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
3436.52
425.81
527.10
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
EPO
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
HMO
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
Medicaid
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
Medicare Part A
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
Medicare Part B
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
POS
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
PPO
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72156
null
cpt
MRI scan of upper spinal canal before and after contrast
humana - medicare advantage
Workers Comp
O
3436.52
425.81
756.35
756.35
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
EPO
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
HMO
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
Medicaid
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
Medicare Part A
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
Medicare Part B
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
POS
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
PPO
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield
Workers Comp
O
3436.52
317.99
317.99
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
EPO
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
HMO
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
POS
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
PPO
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
3436.52
317.99
357.34
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
EPO
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
HMO
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
Medicaid
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
Medicare Part A
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
Medicare Part B
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
POS
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
PPO
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
humana - medicare advantage
Workers Comp
O
3436.52
317.99
766.68
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
EPO
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
HMO
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
Medicaid
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
Medicare Part A
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
Medicare Part B
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
POS
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
PPO
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72157
null
cpt
MRI scan of middle spinal canal before and after contrast
united healthcare
Workers Comp
O
3436.52
317.99
2577.39
2577.39
2061.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
EPO
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
HMO
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
Medicaid
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
Medicare Part A
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
Medicare Part B
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
POS
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
PPO
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield
Workers Comp
O
3608.34
326.01
420.41
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
EPO
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
HMO
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
POS
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
PPO
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
3608.34
326.01
357.34
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
EPO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
HMO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
Medicaid
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
Medicare Part A
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
Medicare Part B
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
POS
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
PPO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
humana - medicare advantage
Workers Comp
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
EPO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
HMO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
Medicaid
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
Medicare Part A
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
Medicare Part B
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
POS
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
PPO
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
tricare
Workers Comp
O
3608.34
326.01
338.27
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
EPO
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
HMO
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
Medicaid
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
Medicare Part A
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
Medicare Part B
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
POS
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
PPO
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72158
null
cpt
MRI scan of lower spinal canal before and after contrast
va
Workers Comp
O
3608.34
326.01
326.01
420.41
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
EPO
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
HMO
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
Medicaid
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
Medicare Part A
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
Medicare Part B
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
POS
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
PPO
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield
Workers Comp
O
213.69
30.90
30.90
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
EPO
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
HMO
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
Medicaid
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
POS
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
PPO
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
30.90
72.55
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
EPO
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
HMO
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
Medicaid
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
Medicare Part A
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
Medicare Part B
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
POS
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
PPO
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
cigna
Workers Comp
O
213.69
30.90
142.67
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
EPO
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
HMO
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
Medicaid
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
Medicare Part A
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
Medicare Part B
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
POS
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
PPO
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
humana - medicare advantage
Workers Comp
O
213.69
30.90
89.76
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
EPO
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
HMO
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
Medicaid
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
Medicare Part A
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
Medicare Part B
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
POS
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
PPO
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72170
null
cpt
X-ray of pelvis 1 or 2 views
tricare
Workers Comp
O
213.69
30.90
96.51
142.67
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
EPO
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
HMO
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
Medicaid
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
Medicare Part A
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
Medicare Part B
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
POS
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
PPO
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72192
null
cpt
CT scan pelvis
humana - medicare advantage
Workers Comp
O
1196.47
99.29
99.29
99.29
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
EPO
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
HMO
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
Medicaid
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
Medicare Part A
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
Medicare Part B
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
POS
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
PPO
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield
Workers Comp
O
1318.90
465.75
477.21
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
EPO
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
HMO
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
POS
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
PPO
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1318.90
465.75
465.75
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
EPO
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
HMO
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
Medicaid
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
Medicare Part A
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
Medicare Part B
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
POS
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
PPO
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72193
null
cpt
CT of Pelvis with contrast
united healthcare
Workers Comp
O
1318.90
465.75
989.18
989.18
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
EPO
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
HMO
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
POS
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
PPO
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72194
null
cpt
CT scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1964.91
500.98
500.98
500.98
1178.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
EPO
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
HMO
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
Medicaid
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
Medicare Part A
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
Medicare Part B
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
POS
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
PPO
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
aetna
Workers Comp
O
1663.93
203.81
1005.34
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
EPO
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
HMO
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
Medicaid
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
Medicare Part A
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
Medicare Part B
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
POS
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
PPO
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
blue cross blue shield
Workers Comp
O
1663.93
203.81
550.21
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
EPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
HMO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
Medicaid
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
Medicare Part A
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
Medicare Part B
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
POS
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
PPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
humana - medicare advantage
Workers Comp
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
EPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
HMO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
Medicaid
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
Medicare Part A
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
Medicare Part B
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
POS
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
PPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
tricare
Workers Comp
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
EPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
HMO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
Medicaid
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
Medicare Part A
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
Medicare Part B
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
POS
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
PPO
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72195
null
cpt
MRI scan of pelvis
va
Workers Comp
O
1663.93
203.81
203.81
1005.34
998.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
EPO
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
HMO
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
Medicaid
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
Medicare Part A
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
Medicare Part B
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
POS
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
PPO
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna
Workers Comp
O
2719.05
326.01
957.66
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
EPO
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
HMO
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
Medicaid
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
Medicare Part A
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
Medicare Part B
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
POS
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
PPO
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
aetna - medicare advantage
Workers Comp
O
2719.05
326.01
331.84
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
EPO
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
HMO
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
Medicaid
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
Medicare Part A
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
Medicare Part B
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
POS
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
PPO
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield
Workers Comp
O
2719.05
326.01
900.23
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
EPO
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
HMO
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
POS
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
PPO
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
326.01
911.61
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
EPO
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
HMO
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
Medicaid
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
Medicare Part A
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
Medicare Part B
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
POS
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
PPO
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
humana - medicare advantage
Workers Comp
O
2719.05
326.01
326.02
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
EPO
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
HMO
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
Medicaid
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
Medicare Part A
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
Medicare Part B
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
POS
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
PPO
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
tricare
Workers Comp
O
2719.05
326.01
332.77
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
EPO
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
HMO
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
Medicaid
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
Medicare Part A
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
Medicare Part B
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
POS
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
PPO
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72197
null
cpt
MRI scan of pelvis before and after contrast
va
Workers Comp
O
2719.05
326.01
326.01
957.66
399.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
EPO
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
HMO
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
Medicaid
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
Medicare Part A
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
Medicare Part B
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
POS
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
PPO
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
aetna
Workers Comp
O
238.18
24.85
143.91
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
EPO
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
HMO
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
Medicaid
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
Medicare Part A
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
Medicare Part B
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
POS
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
PPO
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield
Workers Comp
O
238.18
24.85
26.87
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
EPO
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
HMO
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
Medicaid
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
POS
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
PPO
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
24.85
24.85
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
EPO
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
HMO
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
Medicaid
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
Medicare Part A
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
Medicare Part B
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
POS
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
PPO
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
humana - medicare advantage
Workers Comp
O
238.18
24.85
97.30
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
EPO
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
HMO
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
Medicaid
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
Medicare Part A
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
Medicare Part B
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
POS
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
PPO
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72202
null
cpt
X-ray of sacroiliac joints 3 or more views
united healthcare
Workers Comp
O
238.18
24.85
170.13
170.13
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
EPO
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
HMO
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
Medicaid
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
Medicare Part A
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
Medicare Part B
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
POS
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
PPO
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield
Workers Comp
O
213.69
22.29
24.85
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
22.29
22.29
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
EPO
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
HMO
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
Medicaid
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
Medicare Part A
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
Medicare Part B
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
POS
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
PPO
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
72220
null
cpt
X-ray of pelvis minimum of 2 views
humana - medicare advantage
Workers Comp
O
213.69
22.29
71.65
71.65
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
EPO
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
HMO
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
Medicaid
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
Medicare Part A
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
Medicare Part B
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
POS
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
PPO
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield
Workers Comp
I
21196.30
2407.15
6665.67
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
EPO
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
HMO
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
Medicaid
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
POS
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
PPO
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
21196.30
2407.15
9130.50
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
EPO
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
HMO
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
Medicaid
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
Medicare Part A
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
Medicare Part B
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
POS
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
PPO
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
728
null
ms-drg
inflammation of the male reproductive system without mcc
tricare
Workers Comp
I
21196.30
2407.15
2407.15
9130.50
12717.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
EPO
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
HMO
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
Medicaid
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
Medicare Part A
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
Medicare Part B
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
POS
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
PPO
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield
Workers Comp
O
238.18
46.07
46.07
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
EPO
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
HMO
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
Medicaid
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
POS
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
PPO
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
46.07
53.03
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
EPO
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
HMO
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
Medicaid
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
Medicare Part A
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
Medicare Part B
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
POS
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
PPO
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73000
null
cpt
X-ray of collar bone
cigna
Workers Comp
O
238.18
46.07
168.54
168.54
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
EPO
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
HMO
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
Medicaid
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
Medicare Part A
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
Medicare Part B
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
POS
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
PPO
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
blue cross blue shield
Workers Comp
O
238.18
22.21
22.21
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
EPO
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
HMO
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
Medicaid
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
Medicare Part A
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
Medicare Part B
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
POS
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
PPO
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73010
null
cpt
X-ray of shoulder blade
humana - medicare advantage
Workers Comp
O
238.18
22.21
97.30
97.30
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
EPO
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
HMO
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
Medicaid
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
Medicare Part A
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
Medicare Part B
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
POS
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
PPO
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield
Workers Comp
O
213.69
48.19
95.04
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
EPO
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
HMO
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
Medicaid
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
POS
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
PPO
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
48.19
48.19
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
EPO
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
HMO
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
Medicaid
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
Medicare Part A
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
Medicare Part B
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
POS
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
PPO
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73020
null
cpt
X-ray of shoulder 1 view
va
Workers Comp
O
213.69
48.19
203.52
203.52
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
EPO
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
HMO
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
Medicaid
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
Medicare Part A
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
Medicare Part B
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
POS
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
PPO
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
aetna
Workers Comp
O
238.18
19.87
138.14
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
EPO
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
HMO
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
Medicaid
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
Medicare Part A
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
Medicare Part B
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
POS
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
PPO
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield
Workers Comp
O
238.18
19.87
61.44
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
19.87
61.29
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
EPO
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
HMO
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
Medicaid
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
Medicare Part A
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
Medicare Part B
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
POS
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
PPO
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
cigna
Workers Comp
O
238.18
19.87
159.01
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
EPO
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
HMO
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
Medicaid
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
Medicare Part A
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
Medicare Part B
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
POS
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
PPO
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
healthchoice
Workers Comp
O
238.18
19.87
64.17
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
EPO
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
HMO
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
Medicaid
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
Medicare Part A
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
Medicare Part B
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
POS
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
PPO
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
humana - medicare advantage
Workers Comp
O
238.18
19.87
70.70
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
EPO
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
HMO
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
Medicaid
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
Medicare Part A
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
Medicare Part B
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
POS
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
PPO
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
medica
Workers Comp
O
238.18
19.87
88.13
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
EPO
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
HMO
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
Medicaid
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
Medicare Part A
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
Medicare Part B
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
POS
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
PPO
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
tricare
Workers Comp
O
238.18
19.87
71.65
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
EPO
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
HMO
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
Medicaid
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
Medicare Part A
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
Medicare Part B
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
POS
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
PPO
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
united healthcare
Workers Comp
O
238.18
19.87
174.39
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
EPO
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
HMO
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
Medicaid
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
Medicare Part A
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
Medicare Part B
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
POS
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
PPO
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
va
Workers Comp
O
238.18
19.87
19.87
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
EPO
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
HMO
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
Medicaid
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
Medicare Part A
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
Medicare Part B
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
POS
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
PPO
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73030
null
cpt
X-ray of shoulder minimum of 2 views
webtpa
Workers Comp
O
238.18
19.87
166.73
174.39
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
EPO
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
HMO
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
Medicaid
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
Medicare Part A
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
Medicare Part B
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
POS
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
PPO
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield
Workers Comp
O
1252.12
75.16
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
EPO
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
HMO
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
Medicaid
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
Medicare Part A
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
Medicare Part B
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
POS
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
PPO
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
blue cross blue shield - medicare advantage
Workers Comp
O
1252.12
75.16
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
EPO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
HMO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
Medicaid
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
Medicare Part A
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
Medicare Part B
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
POS
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
PPO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
humana - medicare advantage
Workers Comp
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
EPO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
HMO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
Medicaid
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
Medicare Part A
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
Medicare Part B
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
POS
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
PPO
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
tricare
Workers Comp
O
1252.12
75.16
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
EPO
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
HMO
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
Medicaid
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
Medicare Part A
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
Medicare Part B
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
POS
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
PPO
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73040
null
cpt
Radiological supervision and interpretation X-ray of shoulder joint
va
Workers Comp
O
1252.12
75.16
75.16
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
EPO
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
HMO
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
Medicaid
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
Medicare Part A
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
Medicare Part B
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
POS
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
PPO
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
aetna
Workers Comp
O
218.14
44.06
128.70
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
EPO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
HMO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
Medicaid
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
Medicare Part A
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
Medicare Part B
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
POS
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
PPO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield
Workers Comp
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
218.14
44.06
44.06
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
EPO
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
HMO
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
Medicaid
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
Medicare Part A
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
Medicare Part B
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
POS
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
PPO
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73060
null
cpt
X-ray of upper arm minimum of 2 views
humana - medicare advantage
Workers Comp
O
218.14
44.06
71.65
128.70
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
EPO
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
HMO
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
Medicaid
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
Medicare Part A
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
Medicare Part B
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
POS
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
PPO
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield
Workers Comp
O
224.82
35.12
35.12
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
EPO
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
HMO
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
Medicaid
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
POS
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
PPO
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
224.82
35.12
64.80
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
EPO
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
HMO
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
Medicaid
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
Medicare Part A
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
Medicare Part B
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
POS
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
PPO
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73070
null
cpt
X-ray of elbow 2 views
humana - medicare advantage
Workers Comp
O
224.82
35.12
70.70
70.70
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
EPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
HMO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
Medicaid
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
Medicare Part A
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
Medicare Part B
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
POS
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
PPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
aetna - medicare advantage
Workers Comp
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
EPO
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
HMO
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
Medicaid
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
Medicare Part A
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
Medicare Part B
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
POS
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
PPO
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield
Workers Comp
O
278.25
19.83
61.44
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
278.25
19.83
55.55
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
EPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
HMO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
Medicaid
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
Medicare Part A
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
Medicare Part B
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
POS
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
PPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
humana - medicare advantage
Workers Comp
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
EPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
HMO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
Medicaid
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
Medicare Part A
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
Medicare Part B
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
POS
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
PPO
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
tricare
Workers Comp
O
278.25
19.83
70.70
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
EPO
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
HMO
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
Medicaid
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
Medicare Part A
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
Medicare Part B
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
POS
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
PPO
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73080
null
cpt
X-ray of elbow minimum of 3 views
va
Workers Comp
O
278.25
19.83
19.83
70.70
166.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
EPO
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
HMO
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
Medicaid
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
Medicare Part A
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
Medicare Part B
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
POS
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
PPO
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
aetna
Workers Comp
O
218.14
38.03
122.58
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
EPO
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
HMO
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
Medicaid
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
Medicare Part A
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
Medicare Part B
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
POS
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
PPO
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
blue cross blue shield
Workers Comp
O
218.14
38.03
38.03
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
EPO
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
HMO
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
Medicaid
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
Medicare Part A
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
Medicare Part B
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
POS
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
PPO
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
cigna
Workers Comp
O
218.14
38.03
154.37
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
EPO
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
HMO
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
Medicaid
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
Medicare Part A
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
Medicare Part B
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
POS
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
PPO
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
humana - medicare advantage
Workers Comp
O
218.14
38.03
68.70
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
EPO
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
HMO
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
Medicaid
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
Medicare Part A
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
Medicare Part B
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
POS
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
PPO
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73090
null
cpt
X-ray of forearm 2 views
tricare
Workers Comp
O
218.14
38.03
53.73
154.37
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
EPO
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
HMO
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
Medicaid
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
Medicare Part A
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
Medicare Part B
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
POS
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
PPO
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield
Workers Comp
O
238.18
49.39
81.00
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
EPO
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
HMO
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
Medicaid
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
POS
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
PPO
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
49.39
49.39
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
EPO
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
HMO
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
Medicaid
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
Medicare Part A
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
Medicare Part B
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
POS
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
PPO
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
humana - medicare advantage
Workers Comp
O
238.18
49.39
70.70
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
EPO
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
HMO
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
Medicaid
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
Medicare Part A
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
Medicare Part B
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
POS
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
PPO
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73100
null
cpt
X-ray of wrist 2 views
va
Workers Comp
O
238.18
49.39
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
EPO
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
HMO
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
Medicaid
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
Medicare Part A
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
Medicare Part B
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
POS
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
PPO
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
aetna
Workers Comp
O
310.52
60.90
177.30
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
EPO
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
HMO
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
Medicaid
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
Medicare Part A
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
Medicare Part B
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
POS
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
PPO
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield
Workers Comp
O
310.52
60.90
60.90
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
310.52
60.90
61.44
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
EPO
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
HMO
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
Medicaid
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
Medicare Part A
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
Medicare Part B
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
POS
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
PPO
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
humana - medicare advantage
Workers Comp
O
310.52
60.90
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
EPO
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
HMO
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
Medicaid
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
Medicare Part A
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
Medicare Part B
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
POS
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
PPO
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
tricare
Workers Comp
O
310.52
60.90
71.18
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
EPO
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
HMO
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
Medicaid
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
Medicare Part A
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
Medicare Part B
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
POS
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
PPO
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
united healthcare
Workers Comp
O
310.52
60.90
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
EPO
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
HMO
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
Medicaid
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
Medicare Part A
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
Medicare Part B
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
POS
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
PPO
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
webtpa
Workers Comp
O
310.52
60.90
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
EPO
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
HMO
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
Medicaid
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
Medicare Part A
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
Medicare Part B
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
POS
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
PPO
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73110
null
cpt
X-ray of wrist minimum of 3 views
worker comp
Workers Comp
O
310.52
60.90
100.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
EPO
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
HMO
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
Medicaid
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
Medicare Part A
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
Medicare Part B
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
POS
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
PPO
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73115
null
cpt
Radiological supervision and interpretation X-ray of wrist joint
va
Workers Comp
O
1115.22
326.01
326.01
326.01
669.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
EPO
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
HMO
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
Medicaid
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
Medicare Part A
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
Medicare Part B
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
POS
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
PPO
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield
Workers Comp
O
203.52
41.43
48.96
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
EPO
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
HMO
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
Medicaid
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
POS
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
PPO
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
203.52
41.43
41.43
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
EPO
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
HMO
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
Medicaid
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
Medicare Part A
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
Medicare Part B
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
POS
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
PPO
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73120
null
cpt
X-ray of hand 2 views
humana - medicare advantage
Workers Comp
O
203.52
41.43
97.70
97.70
122.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
EPO
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
HMO
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
Medicaid
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
Medicare Part A
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
Medicare Part B
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
POS
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
PPO
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna
Workers Comp
O
310.52
23.34
174.49
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
EPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
HMO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
Medicaid
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
Medicare Part A
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
Medicare Part B
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
POS
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
PPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
aetna - medicare advantage
Workers Comp
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
EPO
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
HMO
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
Medicaid
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
Medicare Part A
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
Medicare Part B
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
POS
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
PPO
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield
Workers Comp
O
310.52
23.34
46.08
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
310.52
23.34
37.92
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
EPO
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
HMO
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
Medicaid
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
Medicare Part A
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
Medicare Part B
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
POS
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
PPO
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
cigna
Workers Comp
O
310.52
23.34
207.31
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
EPO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
HMO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
Medicaid
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
Medicare Part A
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
Medicare Part B
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
POS
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
PPO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
humana - medicare advantage
Workers Comp
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
EPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
HMO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
Medicaid
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
Medicare Part A
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
Medicare Part B
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
POS
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
PPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
tricare
Workers Comp
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
EPO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
HMO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
Medicaid
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
Medicare Part A
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
Medicare Part B
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
POS
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
PPO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
united healthcare
Workers Comp
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
EPO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
HMO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
Medicaid
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
Medicare Part A
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
Medicare Part B
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
POS
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
PPO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
va
Workers Comp
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
EPO
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
HMO
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
Medicaid
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
Medicare Part A
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
Medicare Part B
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
POS
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
PPO
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
webtpa
Workers Comp
O
310.52
23.34
217.36
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
EPO
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
HMO
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
Medicaid
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
Medicare Part A
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
Medicare Part B
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
POS
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
PPO
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73130
null
cpt
X-ray of hand minimum of 3 views
worker comp
Workers Comp
O
310.52
23.34
100.69
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
EPO
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
HMO
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
Medicaid
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
Medicare Part A
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
Medicare Part B
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
POS
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
PPO
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield
Workers Comp
O
213.69
61.44
80.71
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
61.44
61.44
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
EPO
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
HMO
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
Medicaid
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
Medicare Part A
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
Medicare Part B
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
POS
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
PPO
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
humana - medicare advantage
Workers Comp
O
213.69
61.44
71.18
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
EPO
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
HMO
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
Medicaid
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
Medicare Part A
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
Medicare Part B
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
POS
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
PPO
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
tricare
Workers Comp
O
213.69
61.44
71.65
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
EPO
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
HMO
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
Medicaid
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
Medicare Part A
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
Medicare Part B
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
POS
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
PPO
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73140
null
cpt
X-ray of fingers minimum of 2 views
webtpa
Workers Comp
O
213.69
61.44
149.58
149.58
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
EPO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
HMO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
Medicaid
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
Medicare Part A
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
Medicare Part B
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
POS
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
PPO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield
Workers Comp
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
EPO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
HMO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
Medicaid
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
Medicare Part A
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
Medicare Part B
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
POS
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
PPO
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
blue cross blue shield - medicare advantage
Workers Comp
O
1195.36
97.90
482.16
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
EPO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
HMO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
Medicaid
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
Medicare Part A
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
Medicare Part B
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
POS
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
PPO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
humana - medicare advantage
Workers Comp
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
EPO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
HMO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
Medicaid
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
Medicare Part A
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
Medicare Part B
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
POS
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
PPO
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
tricare
Workers Comp
O
1195.36
97.90
97.90
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
EPO
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
HMO
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
Medicaid
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
Medicare Part A
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
Medicare Part B
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
POS
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
PPO
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73200
null
cpt
CT scan of arm
webtpa
Workers Comp
O
1195.36
97.90
796.91
796.91
717.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
EPO
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
HMO
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
Medicaid
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
Medicare Part A
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
Medicare Part B
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
POS
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
PPO
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield
Workers Comp
O
1318.90
294.17
546.05
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
EPO
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
HMO
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
POS
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
PPO
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1318.90
294.17
294.17
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
EPO
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
HMO
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
Medicaid
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
Medicare Part A
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
Medicare Part B
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
POS
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
PPO
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
humana - medicare advantage
Workers Comp
O
1318.90
294.17
338.27
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
EPO
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
HMO
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
Medicaid
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
Medicare Part A
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
Medicare Part B
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
POS
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
PPO
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
va
Workers Comp
O
1318.90
294.17
325.41
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
EPO
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
HMO
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
Medicaid
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
Medicare Part A
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
Medicare Part B
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
POS
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
PPO
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73201
null
cpt
CT scan of arm with contrast
worker comp
Workers Comp
O
1318.90
294.17
942.08
942.08
791.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
EPO
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
HMO
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
Medicaid
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
Medicare Part A
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
Medicare Part B
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
POS
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
PPO
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield
Workers Comp
O
2719.05
203.81
1017.53
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
1114.84
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
EPO
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
HMO
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
Medicaid
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
POS
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
PPO
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
humana - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
EPO
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
HMO
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
Medicaid
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
Medicare Part A
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
Medicare Part B
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
POS
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
PPO
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
tricare
Workers Comp
O
2719.05
203.81
205.13
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
EPO
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
HMO
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
Medicaid
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
Medicare Part A
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
Medicare Part B
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
POS
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
PPO
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73218
null
cpt
MRI scan of arm
webtpa
Workers Comp
O
2719.05
203.81
1903.34
1903.34
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
EPO
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
HMO
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
Medicaid
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
Medicare Part A
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
Medicare Part B
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
POS
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
PPO
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73220
null
cpt
MRI scan of arm before and after contrast
blue cross blue shield
Workers Comp
O
2719.05
1126.04
1126.04
1126.04
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
EPO
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
HMO
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
Medicaid
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
Medicare Part A
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
Medicare Part B
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
POS
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
PPO
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna
Workers Comp
O
2719.05
203.81
1577.05
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
EPO
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
HMO
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
Medicaid
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
POS
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
PPO
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
1004.52
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
EPO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
HMO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
Medicaid
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
Medicare Part A
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
Medicare Part B
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
POS
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
PPO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield
Workers Comp
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
517.17
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
EPO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
HMO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
Medicaid
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
POS
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
PPO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
humana - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
EPO
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
HMO
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
Medicaid
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
Medicare Part A
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
Medicare Part B
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
POS
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
PPO
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
tricare
Workers Comp
O
2719.05
203.81
205.13
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
EPO
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
HMO
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
Medicaid
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
Medicare Part A
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
Medicare Part B
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
POS
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
PPO
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
united healthcare
Workers Comp
O
2719.05
203.81
2039.29
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
EPO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
HMO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
Medicaid
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
Medicare Part A
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
Medicare Part B
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
POS
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
PPO
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
va
Workers Comp
O
2719.05
203.81
203.81
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
EPO
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
HMO
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
Medicaid
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
Medicare Part A
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
Medicare Part B
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
POS
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
PPO
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73221
null
cpt
MRI scan of arm joint
webtpa
Workers Comp
O
2719.05
203.81
1812.71
2039.29
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
EPO
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
HMO
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
Medicaid
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
Medicare Part A
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
Medicare Part B
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
POS
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
PPO
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
blue cross blue shield
Workers Comp
O
2719.05
603.12
891.88
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
EPO
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
HMO
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
Medicaid
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
Medicare Part A
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
Medicare Part B
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
POS
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
PPO
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
humana - medicare advantage
Workers Comp
O
2719.05
603.12
618.26
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
EPO
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
HMO
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
Medicaid
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
Medicare Part A
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
Medicare Part B
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
POS
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
PPO
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73222
null
cpt
MRI scan of arm joint with contrast
tricare
Workers Comp
O
2719.05
603.12
603.12
891.88
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
EPO
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
HMO
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
Medicaid
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
Medicare Part A
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
Medicare Part B
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
POS
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
PPO
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
blue cross blue shield
Workers Comp
O
3089.68
338.27
475.19
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
EPO
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
HMO
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
Medicaid
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
Medicare Part A
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
Medicare Part B
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
POS
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
PPO
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
humana - medicare advantage
Workers Comp
O
3089.68
338.27
338.27
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
EPO
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
HMO
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
Medicaid
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
Medicare Part A
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
Medicare Part B
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
POS
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
PPO
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73223
null
cpt
MRI scan of arm joint before and after contrast
va
Workers Comp
O
3089.68
338.27
532.81
532.81
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
EPO
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
HMO
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
Medicaid
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
Medicare Part A
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
Medicare Part B
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
POS
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
PPO
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
aetna
Workers Comp
O
201.45
45.40
117.46
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
EPO
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
HMO
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
Medicaid
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
Medicare Part A
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
Medicare Part B
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
POS
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
PPO
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield
Workers Comp
O
201.45
45.40
56.72
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
EPO
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
HMO
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
Medicaid
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
POS
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
PPO
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
blue cross blue shield - medicare advantage
Workers Comp
O
201.45
45.40
45.40
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
EPO
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
HMO
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
Medicaid
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
Medicare Part A
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
Medicare Part B
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
POS
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
PPO
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
humana - medicare advantage
Workers Comp
O
201.45
45.40
70.70
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
EPO
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
HMO
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
Medicaid
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
Medicare Part A
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
Medicare Part B
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
POS
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
PPO
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
tricare
Workers Comp
O
201.45
45.40
71.65
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
EPO
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
HMO
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
Medicaid
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
Medicare Part A
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
Medicare Part B
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
POS
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
PPO
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73502
null
cpt
X-ray of hip with pelvis 2-3 views
webtpa
Workers Comp
O
201.45
45.40
141.02
141.02
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
EPO
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
HMO
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
Medicaid
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
Medicare Part A
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
Medicare Part B
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
POS
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
PPO
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73503
null
cpt
X-ray of hip with pelvis minimum of 4 views
aetna - medicare advantage
Workers Comp
O
319.06
97.40
97.40
97.40
191.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
EPO
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
HMO
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
Medicaid
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
Medicare Part A
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
Medicare Part B
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
POS
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
PPO
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield
Workers Comp
O
335.01
33.24
61.44
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
EPO
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
HMO
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
Medicaid
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
Medicare Part A
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
Medicare Part B
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
POS
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
PPO
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
blue cross blue shield - medicare advantage
Workers Comp
O
335.01
33.24
53.95
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
EPO
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
HMO
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
Medicaid
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
Medicare Part A
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
Medicare Part B
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
POS
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
PPO
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
humana - medicare advantage
Workers Comp
O
335.01
33.24
96.51
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
EPO
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
HMO
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
Medicaid
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
Medicare Part A
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
Medicare Part B
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
POS
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
PPO
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
tricare
Workers Comp
O
335.01
33.24
99.29
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
EPO
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
HMO
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
Medicaid
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
Medicare Part A
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
Medicare Part B
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
POS
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
PPO
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73522
null
cpt
X-ray of both hips with pelvis 3-4 views
va
Workers Comp
O
335.01
33.24
33.24
99.29
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
EPO
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
HMO
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
Medicaid
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
Medicare Part A
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
Medicare Part B
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
POS
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
PPO
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna
Workers Comp
O
636.63
38.22
357.73
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
EPO
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
HMO
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
Medicaid
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
Medicare Part A
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
Medicare Part B
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
POS
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
PPO
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
aetna - medicare advantage
Workers Comp
O
636.63
38.22
99.29
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
EPO
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
HMO
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
Medicaid
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
Medicare Part A
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
Medicare Part B
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
POS
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
PPO
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield
Workers Comp
O
636.63
38.22
61.44
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
EPO
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
HMO
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
Medicaid
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
Medicare Part A
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
Medicare Part B
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
POS
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
PPO
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
blue cross blue shield - medicare advantage
Workers Comp
O
636.63
38.22
59.48
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
EPO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
HMO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
Medicaid
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
Medicare Part A
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
Medicare Part B
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
POS
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
PPO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
humana - medicare advantage
Workers Comp
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
EPO
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
HMO
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
Medicaid
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
Medicare Part A
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
Medicare Part B
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
POS
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
PPO
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
medica
Workers Comp
O
636.63
38.22
235.55
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
EPO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
HMO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
Medicaid
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
Medicare Part A
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
Medicare Part B
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
POS
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
PPO
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
tricare
Workers Comp
O
636.63
38.22
96.51
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
EPO
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
HMO
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
Medicaid
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
Medicare Part A
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
Medicare Part B
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
POS
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
PPO
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
united healthcare
Workers Comp
O
636.63
38.22
454.74
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
EPO
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
HMO
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
Medicaid
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
Medicare Part A
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
Medicare Part B
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
POS
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
PPO
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
va
Workers Comp
O
636.63
38.22
38.22
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
EPO
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
HMO
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
Medicaid
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
Medicare Part A
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
Medicare Part B
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
POS
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
PPO
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73523
null
cpt
X-ray of both hips with pelvis minimum of 5 views
webtpa
Workers Comp
O
636.63
38.22
435.03
454.74
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
EPO
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
HMO
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
Medicaid
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
Medicare Part A
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
Medicare Part B
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
POS
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
PPO
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
humana - medicare advantage
Workers Comp
O
1027.14
335.52
338.27
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
EPO
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
HMO
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
Medicaid
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
Medicare Part A
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
Medicare Part B
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
POS
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
PPO
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73525
null
cpt
Radiological supervision and interpretation X-ray of hip joint
tricare
Workers Comp
O
1027.14
335.52
335.52
338.27
616.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
EPO
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
HMO
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
Medicaid
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
Medicare Part A
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
Medicare Part B
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
POS
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
PPO
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
aetna
Workers Comp
O
291.60
51.81
170.02
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
EPO
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
HMO
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
Medicaid
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
Medicare Part A
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
Medicare Part B
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
POS
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
PPO
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield
Workers Comp
O
291.60
51.81
51.81
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
EPO
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
HMO
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
Medicaid
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
POS
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
PPO
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
291.60
51.81
88.58
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
EPO
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
HMO
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
Medicaid
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
Medicare Part A
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
Medicare Part B
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
POS
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
PPO
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73552
null
cpt
X-ray of femur minimum 2 views
humana - medicare advantage
Workers Comp
O
291.60
51.81
70.70
170.02
174.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
EPO
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
HMO
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
Medicaid
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
Medicare Part A
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
Medicare Part B
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
POS
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
PPO
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
aetna
Workers Comp
O
218.14
42.10
126.52
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
EPO
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
HMO
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
Medicaid
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
Medicare Part A
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
Medicare Part B
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
POS
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
PPO
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield
Workers Comp
O
218.14
42.10
42.10
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
EPO
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
HMO
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
Medicaid
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
POS
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
PPO
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
218.14
42.10
75.08
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
EPO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
HMO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
Medicaid
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
Medicare Part A
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
Medicare Part B
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
POS
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
PPO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
humana - medicare advantage
Workers Comp
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
EPO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
HMO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
Medicaid
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
Medicare Part A
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
Medicare Part B
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
POS
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
PPO
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
tricare
Workers Comp
O
218.14
42.10
70.70
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
EPO
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
HMO
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
Medicaid
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
Medicare Part A
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
Medicare Part B
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
POS
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
PPO
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
united healthcare
Workers Comp
O
218.14
42.10
155.82
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
EPO
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
HMO
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
Medicaid
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
Medicare Part A
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
Medicare Part B
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
POS
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
PPO
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73560
null
cpt
X-ray of knee 1 or 2 views
webtpa
Workers Comp
O
218.14
42.10
145.43
155.82
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
EPO
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
HMO
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
Medicaid
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
Medicare Part A
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
Medicare Part B
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
POS
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
PPO
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
aetna
Workers Comp
O
213.69
61.44
123.94
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
EPO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
HMO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
Medicaid
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
Medicare Part A
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
Medicare Part B
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
POS
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
PPO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield
Workers Comp
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
EPO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
HMO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
Medicaid
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
POS
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
PPO
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
61.44
61.44
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
EPO
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
HMO
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
Medicaid
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
Medicare Part A
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
Medicare Part B
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
POS
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
PPO
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
humana - medicare advantage
Workers Comp
O
213.69
61.44
71.65
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
EPO
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
HMO
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
Medicaid
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
Medicare Part A
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
Medicare Part B
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
POS
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
PPO
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
tricare
Workers Comp
O
213.69
61.44
71.18
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
EPO
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
HMO
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
Medicaid
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
Medicare Part A
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
Medicare Part B
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
POS
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
PPO
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
united healthcare
Workers Comp
O
213.69
61.44
160.27
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
EPO
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
HMO
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
Medicaid
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
Medicare Part A
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
Medicare Part B
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
POS
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
PPO
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
va
Workers Comp
O
213.69
61.44
71.38
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
EPO
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
HMO
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
Medicaid
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
Medicare Part A
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
Medicare Part B
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
POS
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
PPO
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73562
null
cpt
X-ray of knee 3 views
webtpa
Workers Comp
O
213.69
61.44
149.58
160.27
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
EPO
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
HMO
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
Medicaid
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
Medicare Part A
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
Medicare Part B
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
POS
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
PPO
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna
Workers Comp
O
336.12
29.09
194.95
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
EPO
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
HMO
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
Medicaid
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
Medicare Part A
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
Medicare Part B
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
POS
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
PPO
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
aetna - medicare advantage
Workers Comp
O
336.12
29.09
89.75
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
EPO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
HMO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
Medicaid
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
Medicare Part A
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
Medicare Part B
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
POS
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
PPO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield
Workers Comp
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
EPO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
HMO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
Medicaid
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
Medicare Part A
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
Medicare Part B
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
POS
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
PPO
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
blue cross blue shield - medicare advantage
Workers Comp
O
336.12
29.09
61.44
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
EPO
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
HMO
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
Medicaid
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
Medicare Part A
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
Medicare Part B
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
POS
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
PPO
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
cigna
Workers Comp
O
336.12
29.09
237.85
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
EPO
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
HMO
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
Medicaid
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
Medicare Part A
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
Medicare Part B
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
POS
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
PPO
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
humana - medicare advantage
Workers Comp
O
336.12
29.09
96.51
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
EPO
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
HMO
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
Medicaid
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
Medicare Part A
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
Medicare Part B
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
POS
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
PPO
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
tricare
Workers Comp
O
336.12
29.09
99.29
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
EPO
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
HMO
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
Medicaid
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
Medicare Part A
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
Medicare Part B
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
POS
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
PPO
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
united healthcare
Workers Comp
O
336.12
29.09
240.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
EPO
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
HMO
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
Medicaid
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
Medicare Part A
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
Medicare Part B
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
POS
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
PPO
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
va
Workers Comp
O
336.12
29.09
29.09
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
EPO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
HMO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
Medicaid
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
Medicare Part A
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
Medicare Part B
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
POS
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
PPO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
webtpa
Workers Comp
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
EPO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
HMO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
Medicaid
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
Medicare Part A
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
Medicare Part B
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
POS
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
PPO
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73564
null
cpt
X-ray of knee 4 or more views
worker comp
Workers Comp
O
336.12
29.09
224.08
240.09
201.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
EPO
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
HMO
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
Medicaid
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
Medicare Part A
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
Medicare Part B
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
POS
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
PPO
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield
Workers Comp
O
318.31
38.30
81.96
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
EPO
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
HMO
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
Medicaid
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
Medicare Part A
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
Medicare Part B
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
POS
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
PPO
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73565
null
cpt
X-ray of both knees standing front to back view
blue cross blue shield - medicare advantage
Workers Comp
O
318.31
38.30
38.30
81.96
190.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
EPO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
HMO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
Medicaid
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
Medicare Part A
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
Medicare Part B
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
POS
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
PPO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield
Workers Comp
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
EPO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
HMO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
Medicaid
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
POS
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
PPO
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
61.44
61.44
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
EPO
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
HMO
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
Medicaid
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
Medicare Part A
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
Medicare Part B
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
POS
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
PPO
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
humana - medicare advantage
Workers Comp
O
238.18
61.44
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
EPO
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
HMO
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
Medicaid
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
Medicare Part A
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
Medicare Part B
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
POS
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
PPO
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73590
null
cpt
X-ray of lower leg 2 views
tricare
Workers Comp
O
238.18
61.44
70.70
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
EPO
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
HMO
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
Medicaid
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
Medicare Part A
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
Medicare Part B
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
POS
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
PPO
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
blue cross blue shield
Workers Comp
O
238.18
39.02
39.02
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
EPO
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
HMO
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
Medicaid
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
Medicare Part A
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
Medicare Part B
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
POS
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
PPO
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73600
null
cpt
X-ray of ankle 2 views
tricare
Workers Comp
O
238.18
39.02
71.65
71.65
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
EPO
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
HMO
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
Medicaid
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
Medicare Part A
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
Medicare Part B
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
POS
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
PPO
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
aetna
Workers Comp
O
310.52
23.34
180.10
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
EPO
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
HMO
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
Medicaid
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
Medicare Part A
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
Medicare Part B
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
POS
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
PPO
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield
Workers Comp
O
310.52
23.34
54.72
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
310.52
23.34
51.58
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
EPO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
HMO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
Medicaid
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
Medicare Part A
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
Medicare Part B
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
POS
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
PPO
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
humana - medicare advantage
Workers Comp
O
310.52
23.34
71.65
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
EPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
HMO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
Medicaid
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
Medicare Part A
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
Medicare Part B
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
POS
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
PPO
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
tricare
Workers Comp
O
310.52
23.34
70.70
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
EPO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
HMO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
Medicaid
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
Medicare Part A
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
Medicare Part B
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
POS
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
PPO
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
united healthcare
Workers Comp
O
310.52
23.34
232.89
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
EPO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
HMO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
Medicaid
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
Medicare Part A
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
Medicare Part B
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
POS
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
PPO
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
va
Workers Comp
O
310.52
23.34
23.34
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
EPO
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
HMO
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
Medicaid
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
Medicare Part A
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
Medicare Part B
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
POS
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
PPO
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73610
null
cpt
X-ray of ankle minimum of 3 views
webtpa
Workers Comp
O
310.52
23.34
207.02
232.89
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
EPO
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
HMO
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
Medicaid
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
Medicare Part A
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
Medicare Part B
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
POS
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
PPO
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield
Workers Comp
O
238.18
27.37
46.08
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
EPO
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
HMO
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
Medicaid
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
POS
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
PPO
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
27.37
27.37
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
EPO
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
HMO
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
Medicaid
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
Medicare Part A
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
Medicare Part B
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
POS
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
PPO
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73620
null
cpt
X-ray of foot 2 views
humana - medicare advantage
Workers Comp
O
238.18
27.37
71.18
71.18
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
EPO
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
HMO
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
Medicaid
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
Medicare Part A
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
Medicare Part B
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
POS
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
PPO
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna
Workers Comp
O
310.52
22.74
125.20
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
EPO
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
HMO
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
Medicaid
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
Medicare Part A
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
Medicare Part B
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
POS
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
PPO
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
aetna - medicare advantage
Workers Comp
O
310.52
22.74
70.29
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
EPO
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
HMO
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
Medicaid
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
Medicare Part A
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
Medicare Part B
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
POS
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
PPO
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield
Workers Comp
O
310.52
22.74
55.90
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
310.52
22.74
58.96
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
EPO
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
HMO
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
Medicaid
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
Medicare Part A
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
Medicare Part B
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
POS
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
PPO
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
humana - medicare advantage
Workers Comp
O
310.52
22.74
71.65
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
EPO
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
HMO
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
Medicaid
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
Medicare Part A
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
Medicare Part B
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
POS
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
PPO
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
tricare
Workers Comp
O
310.52
22.74
70.70
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
EPO
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
HMO
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
Medicaid
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
Medicare Part A
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
Medicare Part B
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
POS
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
PPO
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare
Workers Comp
O
310.52
22.74
221.81
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
EPO
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
HMO
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
Medicaid
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
Medicare Part A
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
Medicare Part B
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
POS
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
PPO
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
united healthcare - medicare advantage
Workers Comp
O
310.52
22.74
69.71
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
EPO
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
HMO
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
Medicaid
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
Medicare Part A
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
Medicare Part B
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
POS
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
PPO
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
webtpa
Workers Comp
O
310.52
22.74
207.02
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
EPO
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
HMO
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
Medicaid
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
Medicare Part A
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
Medicare Part B
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
POS
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
PPO
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73630
null
cpt
X-ray of foot minimum of 3 views
worker comp
Workers Comp
O
310.52
22.74
22.74
221.81
186.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
EPO
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
HMO
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
Medicaid
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
Medicare Part A
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
Medicare Part B
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
POS
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
PPO
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
aetna
Workers Comp
O
213.69
33.17
135.56
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
EPO
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
HMO
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
Medicaid
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
Medicare Part A
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
Medicare Part B
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
POS
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
PPO
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield
Workers Comp
O
213.69
33.17
33.17
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
213.69
33.17
92.31
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
EPO
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
HMO
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
Medicaid
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
Medicare Part A
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
Medicare Part B
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
POS
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
PPO
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73650
null
cpt
X-ray of heel minimum of 2 views
humana - medicare advantage
Workers Comp
O
213.69
33.17
71.65
135.56
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
EPO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
HMO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
Medicaid
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
Medicare Part A
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
Medicare Part B
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
POS
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
PPO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
aetna - medicare advantage
Workers Comp
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
EPO
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
HMO
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
Medicaid
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
Medicare Part A
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
Medicare Part B
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
POS
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
PPO
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield
Workers Comp
O
218.14
53.64
53.64
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
EPO
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
HMO
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
Medicaid
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part A
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
Medicare Part B
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
POS
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
PPO
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
blue cross blue shield - medicare advantage
Workers Comp
O
218.14
53.64
61.44
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
EPO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
HMO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
Medicaid
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
Medicare Part A
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
Medicare Part B
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
POS
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
PPO
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
humana - medicare advantage
Workers Comp
O
218.14
53.64
70.70
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
EPO
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
HMO
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
Medicaid
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
Medicare Part A
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
Medicare Part B
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
POS
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
PPO
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
tricare
Workers Comp
O
218.14
53.64
71.65
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
EPO
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
HMO
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
Medicaid
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
Medicare Part A
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
Medicare Part B
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
POS
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
PPO
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73660
null
cpt
X-ray of toes minimum of 2 views
webtpa
Workers Comp
O
218.14
53.64
149.07
149.07
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
EPO
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
HMO
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
Medicaid
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
Medicare Part A
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
Medicare Part B
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
POS
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
PPO
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna
Workers Comp
O
1316.67
96.50
763.67
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
EPO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
HMO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
Medicaid
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
Medicare Part A
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
Medicare Part B
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
POS
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
PPO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
aetna - medicare advantage
Workers Comp
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
EPO
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
HMO
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
Medicaid
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
Medicare Part A
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
Medicare Part B
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
POS
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
PPO
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield
Workers Comp
O
1316.67
96.50
482.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
EPO
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
HMO
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
Medicaid
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
Medicare Part A
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
Medicare Part B
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
POS
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
PPO
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
blue cross blue shield - medicare advantage
Workers Comp
O
1316.67
96.50
441.44
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
EPO
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
HMO
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
Medicaid
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
Medicare Part A
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
Medicare Part B
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
POS
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
PPO
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
humana - medicare advantage
Workers Comp
O
1316.67
96.50
97.90
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
EPO
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
HMO
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
Medicaid
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
Medicare Part A
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
Medicare Part B
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
POS
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
PPO
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
tricare
Workers Comp
O
1316.67
96.50
98.16
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
EPO
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
HMO
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
Medicaid
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
Medicare Part A
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
Medicare Part B
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
POS
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
PPO
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare
Workers Comp
O
1316.67
96.50
940.49
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
EPO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
HMO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
Medicaid
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
Medicare Part A
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
Medicare Part B
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
POS
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
PPO
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
united healthcare - medicare advantage
Workers Comp
O
1316.67
96.50
99.29
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
EPO
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
HMO
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
Medicaid
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
Medicare Part A
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
Medicare Part B
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
POS
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
PPO
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
va
Workers Comp
O
1316.67
96.50
96.50
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
EPO
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
HMO
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
Medicaid
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
Medicare Part A
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
Medicare Part B
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
POS
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
PPO
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73700
null
cpt
CT scan leg
webtpa
Workers Comp
O
1316.67
96.50
899.73
940.49
790.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
EPO
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
HMO
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
Medicaid
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
Medicare Part A
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
Medicare Part B
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
POS
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
PPO
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73702
null
cpt
CT scan of leg before and after contrast injection
tricare
Workers Comp
O
2102.45
161.43
161.43
161.43
1261.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
EPO
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
HMO
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
Medicaid
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
Medicare Part A
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
Medicare Part B
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
POS
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
PPO
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73706
null
cpt
CT scan of lower leg blood vessels with contrast
humana - medicare advantage
Workers Comp
O
1737.39
161.43
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
EPO
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
HMO
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
Medicaid
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
Medicare Part A
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
Medicare Part B
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
POS
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
PPO
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield
Workers Comp
O
2719.05
187.27
1017.53
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
EPO
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
HMO
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
POS
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
PPO
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
187.27
557.42
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
EPO
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
HMO
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
Medicaid
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
Medicare Part A
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
Medicare Part B
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
POS
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
PPO
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
humana - medicare advantage
Workers Comp
O
2719.05
187.27
203.81
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
EPO
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
HMO
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
Medicaid
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
Medicare Part A
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
Medicare Part B
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
POS
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
PPO
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
tricare
Workers Comp
O
2719.05
187.27
206.45
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
EPO
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
HMO
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
Medicaid
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
Medicare Part A
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
Medicare Part B
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
POS
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
PPO
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
va
Workers Comp
O
2719.05
187.27
187.27
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
EPO
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
HMO
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
Medicaid
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
Medicare Part A
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
Medicare Part B
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
POS
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
PPO
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73718
null
cpt
MRI scan of leg
webtpa
Workers Comp
O
2719.05
187.27
1812.71
1812.71
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
EPO
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
HMO
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
Medicaid
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
Medicare Part A
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
Medicare Part B
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
POS
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
PPO
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
aetna
Workers Comp
O
2719.05
325.41
1671.67
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
EPO
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
HMO
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
Medicaid
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
Medicare Part A
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
Medicare Part B
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
POS
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
PPO
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield
Workers Comp
O
2719.05
325.41
904.08
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
EPO
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
HMO
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
POS
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
PPO
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
325.41
942.36
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
EPO
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
HMO
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
Medicaid
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
Medicare Part A
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
Medicare Part B
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
POS
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
PPO
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
humana - medicare advantage
Workers Comp
O
2719.05
325.41
332.15
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
EPO
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
HMO
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
Medicaid
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
Medicare Part A
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
Medicare Part B
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
POS
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
PPO
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
tricare
Workers Comp
O
2719.05
325.41
326.02
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
EPO
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
HMO
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
Medicaid
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
Medicare Part A
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
Medicare Part B
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
POS
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
PPO
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73720
null
cpt
MRI scan of leg before and after contrast
va
Workers Comp
O
2719.05
325.41
325.41
1671.67
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
EPO
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
HMO
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
Medicaid
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
Medicare Part A
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
Medicare Part B
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
POS
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
PPO
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna
Workers Comp
O
2719.05
203.81
1577.05
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
EPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
HMO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
Medicaid
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
POS
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
PPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
aetna - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
EPO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
HMO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
Medicaid
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
Medicare Part A
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
Medicare Part B
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
POS
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
PPO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield
Workers Comp
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
EPO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
HMO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
Medicaid
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
Medicare Part A
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
Medicare Part B
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
POS
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
PPO
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
blue cross blue shield - medicare advantage
Workers Comp
O
2719.05
203.81
517.17
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
EPO
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
HMO
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
Medicaid
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
Medicare Part A
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
Medicare Part B
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
POS
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
PPO
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
cigna
Workers Comp
O
2719.05
203.81
1924.06
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
EPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
HMO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
Medicaid
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
POS
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
PPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
humana - medicare advantage
Workers Comp
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
EPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
HMO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
Medicaid
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
Medicare Part A
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
Medicare Part B
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
POS
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
PPO
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
tricare
Workers Comp
O
2719.05
203.81
206.45
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
EPO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
HMO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
Medicaid
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
Medicare Part A
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
Medicare Part B
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
POS
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
PPO
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
united healthcare
Workers Comp
O
2719.05
203.81
1942.19
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
EPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
HMO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
Medicaid
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
Medicare Part A
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
Medicare Part B
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
POS
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
PPO
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
va
Workers Comp
O
2719.05
203.81
203.81
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
EPO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
HMO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
Medicaid
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
Medicare Part A
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
Medicare Part B
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
POS
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
PPO
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73721
null
cpt
MRI of Leg Joint
webtpa
Workers Comp
O
2719.05
203.81
1812.71
1942.19
247.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
EPO
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
HMO
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
Medicaid
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
Medicare Part A
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
Medicare Part B
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
POS
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
PPO
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73722
null
cpt
MRI scan of leg joint with contrast
tricare
Workers Comp
O
1844.60
599.83
599.83
599.83
1106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
EPO
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
HMO
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
Medicaid
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
Medicare Part A
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
Medicare Part B
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
POS
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
PPO
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
aetna
Workers Comp
O
3089.68
332.77
1807.46
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
EPO
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
HMO
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
POS
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
PPO
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
3089.68
332.77
919.58
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
EPO
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
HMO
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
Medicaid
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
Medicare Part A
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
Medicare Part B
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
POS
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
PPO
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
humana - medicare advantage
Workers Comp
O
3089.68
332.77
338.27
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
EPO
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
HMO
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
Medicaid
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
Medicare Part A
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
Medicare Part B
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
POS
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
PPO
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
73723
null
cpt
MRI scan of leg joint before and after contrast
tricare
Workers Comp
O
3089.68
332.77
332.77
1807.46
1853.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
EPO
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
HMO
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
Medicaid
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
Medicare Part A
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
Medicare Part B
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
POS
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
PPO
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna
Workers Comp
O
253.76
44.78
147.18
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
EPO
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
HMO
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
Medicaid
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
Medicare Part A
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
Medicare Part B
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
POS
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
PPO
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
aetna - medicare advantage
Workers Comp
O
253.76
44.78
69.29
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
EPO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
HMO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
Medicaid
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
Medicare Part A
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
Medicare Part B
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
POS
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
PPO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield
Workers Comp
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
EPO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
HMO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
Medicaid
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
Medicare Part A
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
Medicare Part B
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
POS
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
PPO
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
blue cross blue shield - medicare advantage
Workers Comp
O
253.76
44.78
61.44
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
EPO
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
HMO
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
Medicaid
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
Medicare Part A
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
Medicare Part B
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
POS
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
PPO
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
cigna
Workers Comp
O
253.76
44.78
179.57
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
EPO
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
HMO
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
Medicaid
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
Medicare Part A
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
Medicare Part B
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
POS
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
PPO
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
humana - medicare advantage
Workers Comp
O
253.76
44.78
71.65
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
EPO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
HMO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
Medicaid
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
Medicare Part A
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
Medicare Part B
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
POS
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
PPO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
tricare
Workers Comp
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
EPO
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
HMO
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
Medicaid
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
Medicare Part A
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
Medicare Part B
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
POS
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
PPO
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare
Workers Comp
O
253.76
44.78
181.26
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
EPO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
HMO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
Medicaid
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
Medicare Part A
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
Medicare Part B
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
POS
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
PPO
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
united healthcare - medicare advantage
Workers Comp
O
253.76
44.78
70.70
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
EPO
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
HMO
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
Medicaid
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
Medicare Part A
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
Medicare Part B
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
POS
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
PPO
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
va
Workers Comp
O
253.76
44.78
44.78
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
EPO
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
HMO
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
Medicaid
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
Medicare Part A
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
Medicare Part B
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
POS
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
PPO
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74018
null
cpt
X-ray of abdomen 1 view
webtpa
Workers Comp
O
253.76
44.78
177.63
181.26
84.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
EPO
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
HMO
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
Medicaid
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
Medicare Part A
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
Medicare Part B
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
POS
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
PPO
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
humana - medicare advantage
Workers Comp
O
324.99
96.51
99.29
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
EPO
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
HMO
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
Medicaid
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
Medicare Part A
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
Medicare Part B
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
POS
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
PPO
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74019
null
cpt
X-ray of abdomen 2 views
tricare
Workers Comp
O
324.99
96.51
96.51
99.29
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
EPO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
HMO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
Medicaid
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
Medicare Part A
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
Medicare Part B
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
POS
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
PPO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield
Workers Comp
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
EPO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
HMO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
Medicaid
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part A
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
Medicare Part B
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
POS
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
PPO
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
blue cross blue shield - medicare advantage
Workers Comp
O
365.06
25.25
61.44
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
EPO
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
HMO
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
Medicaid
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
Medicare Part A
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
Medicare Part B
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
POS
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
PPO
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
humana - medicare advantage
Workers Comp
O
365.06
25.25
96.51
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
EPO
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
HMO
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
Medicaid
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
Medicare Part A
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
Medicare Part B
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
POS
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
PPO
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
tricare
Workers Comp
O
365.06
25.25
99.29
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
EPO
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
HMO
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
Medicaid
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
Medicare Part A
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
Medicare Part B
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
POS
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
PPO
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
united healthcare
Workers Comp
O
365.06
25.25
260.76
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
EPO
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
HMO
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
Medicaid
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
Medicare Part A
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
Medicare Part B
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
POS
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
PPO
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
va
Workers Comp
O
365.06
25.25
25.25
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
EPO
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
HMO
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
Medicaid
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
Medicare Part A
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
Medicare Part B
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
POS
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
PPO
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74021
null
cpt
X-ray of abdomen minimum of 3 views
webtpa
Workers Comp
O
365.06
25.25
249.46
260.76
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
EPO
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
HMO
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
Medicaid
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
Medicare Part A
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
Medicare Part B
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
POS
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
PPO
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
blue cross blue shield
Workers Comp
O
466.40
74.12
74.12
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
EPO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
HMO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
Medicaid
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
Medicare Part A
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
Medicare Part B
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
POS
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
PPO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
humana - medicare advantage
Workers Comp
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
EPO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
HMO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
Medicaid
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
Medicare Part A
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
Medicare Part B
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
POS
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
PPO
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
tricare
Workers Comp
O
466.40
74.12
96.51
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
EPO
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
HMO
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
Medicaid
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
Medicare Part A
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
Medicare Part B
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
POS
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
PPO
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74022
null
cpt
Complete X-ray study of abdomen with single X-ray of chest
united healthcare
Workers Comp
O
466.40
74.12
349.80
349.80
114.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
EPO
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
HMO
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
Medicaid
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
Medicare Part A
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
Medicare Part B
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
POS
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
PPO
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
aetna
Workers Comp
O
1196.47
96.50
693.95
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
EPO
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
HMO
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
Medicaid
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
Medicare Part A
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
Medicare Part B
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
POS
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
PPO
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield
Workers Comp
O
1196.47
96.50
592.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
EPO
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
HMO
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
Medicaid
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
Medicare Part A
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
Medicare Part B
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
POS
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
PPO
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
blue cross blue shield - medicare advantage
Workers Comp
O
1196.47
96.50
555.55
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
EPO
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
HMO
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
Medicaid
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
Medicare Part A
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
Medicare Part B
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
POS
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
PPO
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
humana - medicare advantage
Workers Comp
O
1196.47
96.50
98.16
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
EPO
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
HMO
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
Medicaid
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
Medicare Part A
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
Medicare Part B
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
POS
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
PPO
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74150
null
cpt
CT scan abdomen
va
Workers Comp
O
1196.47
96.50
96.50
693.95
717.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
EPO
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
HMO
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
Medicaid
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
Medicare Part A
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
Medicare Part B
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
POS
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
PPO
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
aetna - medicare advantage
Workers Comp
O
1879.85
49.81
160.63
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
EPO
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
HMO
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
Medicaid
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
Medicare Part A
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
Medicare Part B
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
POS
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
PPO
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield
Workers Comp
O
1879.85
49.81
438.41
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
EPO
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
HMO
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
POS
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
PPO
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1879.85
49.81
499.85
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
EPO
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
HMO
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
Medicaid
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
Medicare Part A
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
Medicare Part B
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
POS
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
PPO
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
healthchoice
Workers Comp
O
1879.85
49.81
49.81
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
EPO
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
HMO
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
Medicaid
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
Medicare Part A
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
Medicare Part B
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
POS
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
PPO
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
humana - medicare advantage
Workers Comp
O
1879.85
49.81
271.75
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
EPO
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
HMO
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
Medicaid
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
Medicare Part A
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
Medicare Part B
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
POS
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
PPO
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74160
null
cpt
CT scan abdomen with contrast
united healthcare
Workers Comp
O
1879.85
49.81
1342.76
1342.76
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
EPO
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
HMO
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
Medicaid
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
Medicare Part A
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
Medicare Part B
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
POS
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
PPO
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield
Workers Comp
O
2410.75
158.13
1825.19
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
EPO
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
HMO
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
POS
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
PPO
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2410.75
158.13
523.21
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
EPO
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
HMO
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
Medicaid
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
Medicare Part A
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
Medicare Part B
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
POS
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
PPO
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
humana - medicare advantage
Workers Comp
O
2410.75
158.13
158.13
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
EPO
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
HMO
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
Medicaid
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
Medicare Part A
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
Medicare Part B
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
POS
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
PPO
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74170
null
cpt
CT scan abdomen before and after contrast
va
Workers Comp
O
2410.75
158.13
161.46
1825.19
1446.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
EPO
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
HMO
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
Medicaid
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
POS
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
PPO
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
1638.33
326.01
418.68
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
EPO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
HMO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
Medicaid
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
Medicare Part A
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
Medicare Part B
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
POS
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
PPO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
humana - medicare advantage
Workers Comp
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
EPO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
HMO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
Medicaid
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
Medicare Part A
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
Medicare Part B
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
POS
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
PPO
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
tricare
Workers Comp
O
1638.33
326.01
326.02
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
EPO
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
HMO
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
Medicaid
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
Medicare Part A
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
Medicare Part B
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
POS
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
PPO
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74174
null
cpt
CT scan of abdominal and pelvic blood vessels with contrast
va
Workers Comp
O
1638.33
326.01
326.01
418.68
392.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
EPO
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
HMO
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
Medicaid
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
Medicare Part A
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
Medicare Part B
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
POS
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
PPO
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
humana - medicare advantage
Workers Comp
O
1737.39
158.13
161.43
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
EPO
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
HMO
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
Medicaid
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
Medicare Part A
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
Medicare Part B
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
POS
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
PPO
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74175
null
cpt
CT scan of abdominal blood vessels with contrast
va
Workers Comp
O
1737.39
158.13
158.13
161.43
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
EPO
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
HMO
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
Medicaid
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
Medicare Part A
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
Medicare Part B
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
POS
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
PPO
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna
Workers Comp
O
2391.83
203.81
1365.62
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
EPO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
HMO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
Medicaid
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
Medicare Part A
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
Medicare Part B
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
POS
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
PPO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
aetna - medicare advantage
Workers Comp
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
EPO
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
HMO
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
Medicaid
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
Medicare Part A
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
Medicare Part B
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
POS
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
PPO
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield
Workers Comp
O
2391.83
203.81
592.16
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
EPO
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
HMO
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
Medicaid
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
Medicare Part A
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
Medicare Part B
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
POS
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
PPO
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
blue cross blue shield - medicare advantage
Workers Comp
O
2391.83
203.81
1199.36
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
EPO
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
HMO
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
Medicaid
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
Medicare Part A
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
Medicare Part B
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
POS
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
PPO
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
humana - medicare advantage
Workers Comp
O
2391.83
203.81
205.13
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
EPO
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
HMO
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
Medicaid
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
Medicare Part A
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
Medicare Part B
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
POS
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
PPO
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
tricare
Workers Comp
O
2391.83
203.81
206.45
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
EPO
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
HMO
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
Medicaid
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
Medicare Part A
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
Medicare Part B
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
POS
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
PPO
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare
Workers Comp
O
2391.83
203.81
1708.46
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
EPO
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
HMO
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
Medicaid
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
Medicare Part A
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
Medicare Part B
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
POS
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
PPO
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
united healthcare - medicare advantage
Workers Comp
O
2391.83
203.81
214.42
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
EPO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
HMO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
Medicaid
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
Medicare Part A
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
Medicare Part B
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
POS
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
PPO
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
va
Workers Comp
O
2391.83
203.81
203.81
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
EPO
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
HMO
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
Medicaid
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
Medicare Part A
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
Medicare Part B
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
POS
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
PPO
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74176
null
cpt
CT scan of abdomen and pelvis
webtpa
Workers Comp
O
2391.83
203.81
1674.28
1708.46
244.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
EPO
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
HMO
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
Medicaid
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
Medicare Part A
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
Medicare Part B
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
POS
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
PPO
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna
Workers Comp
O
3199.87
326.01
1855.92
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
EPO
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
HMO
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
Medicaid
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
Medicare Part A
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
Medicare Part B
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
POS
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
PPO
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
aetna - medicare advantage
Workers Comp
O
3199.87
326.01
396.96
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
EPO
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
HMO
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
Medicaid
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
Medicare Part A
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
Medicare Part B
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
POS
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
PPO
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield
Workers Comp
O
3199.87
326.01
532.99
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
EPO
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
HMO
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
Medicaid
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
Medicare Part A
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
Medicare Part B
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
POS
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
PPO
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
blue cross blue shield - medicare advantage
Workers Comp
O
3199.87
326.01
534.23
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
EPO
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
HMO
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
Medicaid
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
Medicare Part A
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
Medicare Part B
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
POS
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
PPO
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
cigna
Workers Comp
O
3199.87
326.01
2136.30
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
EPO
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
HMO
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
Medicaid
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
Medicare Part A
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
Medicare Part B
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
POS
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
PPO
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
humana - medicare advantage
Workers Comp
O
3199.87
326.01
385.37
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
EPO
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
HMO
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
Medicaid
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
Medicare Part A
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
Medicare Part B
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
POS
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
PPO
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
tricare
Workers Comp
O
3199.87
326.01
361.82
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
EPO
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
HMO
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
Medicaid
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
Medicare Part A
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
Medicare Part B
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
POS
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
PPO
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare
Workers Comp
O
3199.87
326.01
2399.90
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
EPO
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
HMO
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
Medicaid
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
Medicare Part A
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
Medicare Part B
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
POS
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
PPO
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
united healthcare - medicare advantage
Workers Comp
O
3199.87
326.01
403.59
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
EPO
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
HMO
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
Medicaid
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
Medicare Part A
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
Medicare Part B
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
POS
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
PPO
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74177
null
cpt
CT of Abdomen and Pelvis with contracts
va
Workers Comp
O
3199.87
326.01
326.01
2399.90
462.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
EPO
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
HMO
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
Medicaid
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
Medicare Part A
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
Medicare Part B
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
POS
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
PPO
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna
Workers Comp
O
4318.44
326.01
2547.88
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
EPO
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
HMO
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
Medicaid
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
Medicare Part A
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
Medicare Part B
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
POS
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
PPO
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
aetna - medicare advantage
Workers Comp
O
4318.44
326.01
326.71
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
EPO
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
HMO
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
Medicaid
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
Medicare Part A
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
Medicare Part B
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
POS
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
PPO
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield
Workers Comp
O
4318.44
326.01
551.58
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
EPO
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
HMO
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicaid
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
POS
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
PPO
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
blue cross blue shield - medicare advantage
Workers Comp
O
4318.44
326.01
552.10
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
EPO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
HMO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
Medicaid
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
Medicare Part A
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
Medicare Part B
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
POS
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
PPO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
humana - medicare advantage
Workers Comp
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
EPO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
HMO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
Medicaid
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
Medicare Part A
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
Medicare Part B
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
POS
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
PPO
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
tricare
Workers Comp
O
4318.44
326.01
338.27
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
EPO
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
HMO
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
Medicaid
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
Medicare Part A
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
Medicare Part B
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
POS
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
PPO
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
united healthcare - medicare advantage
Workers Comp
O
4318.44
326.01
331.51
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
EPO
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
HMO
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
Medicaid
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
Medicare Part A
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
Medicare Part B
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
POS
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
PPO
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74178
null
cpt
CT scan of abdomen and pelvis before and after contrast
va
Workers Comp
O
4318.44
326.01
326.01
2547.88
400.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
EPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
HMO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
Medicaid
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
Medicare Part A
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
Medicare Part B
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
POS
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
PPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
humana - medicare advantage
Workers Comp
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
EPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
HMO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
Medicaid
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
Medicare Part A
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
Medicare Part B
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
POS
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
PPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
tricare
Workers Comp
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
EPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
HMO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
Medicaid
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
Medicare Part A
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
Medicare Part B
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
POS
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
PPO
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74181
null
cpt
MRI scan of abdomen
va
Workers Comp
O
2719.05
203.81
203.81
203.81
1631.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
EPO
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
HMO
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
Medicaid
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
Medicare Part A
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
Medicare Part B
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
POS
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
PPO
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
blue cross blue shield
Workers Comp
O
3608.34
326.01
1127.97
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
EPO
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
HMO
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
Medicaid
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
Medicare Part A
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
Medicare Part B
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
POS
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
PPO
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
humana - medicare advantage
Workers Comp
O
3608.34
326.01
332.86
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
EPO
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
HMO
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
Medicaid
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
Medicare Part A
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
Medicare Part B
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
POS
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
PPO
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
tricare
Workers Comp
O
3608.34
326.01
338.27
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
EPO
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
HMO
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
Medicaid
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
Medicare Part A
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
Medicare Part B
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
POS
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
PPO
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74183
null
cpt
MRI scan of abdomen before and after contrast
va
Workers Comp
O
3608.34
326.01
326.01
1127.97
2165.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
EPO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
HMO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
Medicaid
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
Medicare Part A
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
Medicare Part B
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
POS
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
PPO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield
Workers Comp
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
EPO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
HMO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
Medicaid
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
POS
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
PPO
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
blue cross blue shield - medicare advantage
Workers Comp
O
520.88
55.19
55.19
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
EPO
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
HMO
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
Medicaid
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
Medicare Part A
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
Medicare Part B
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
POS
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
PPO
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
humana - medicare advantage
Workers Comp
O
520.88
55.19
161.43
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
EPO
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
HMO
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
Medicaid
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
Medicare Part A
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
Medicare Part B
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
POS
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
PPO
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74220
null
cpt
X-ray of esophagus with single contrast
va
Workers Comp
O
520.88
55.19
158.13
161.43
193.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
EPO
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
HMO
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
Medicaid
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
Medicare Part A
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
Medicare Part B
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
POS
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
PPO
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield
Workers Comp
O
740.14
157.84
337.93
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
EPO
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
HMO
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicaid
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicare Part A
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicare Part B
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
POS
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
PPO
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
blue cross blue shield - medicare advantage
Workers Comp
O
740.14
157.84
252.79
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
EPO
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
HMO
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
Medicaid
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
Medicare Part A
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
Medicare Part B
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
POS
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
PPO
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
humana - medicare advantage
Workers Comp
O
740.14
157.84
158.13
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
EPO
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
HMO
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
Medicaid
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
Medicare Part A
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
Medicare Part B
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
POS
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
PPO
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
tricare
Workers Comp
O
740.14
157.84
161.43
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
EPO
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
HMO
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
Medicaid
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
Medicare Part A
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
Medicare Part B
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
POS
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
PPO
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74230
null
cpt
Imaging for evaluation of swallowing function
va
Workers Comp
O
740.14
157.84
157.84
337.93
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
EPO
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
HMO
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
Medicaid
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
Medicare Part A
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
Medicare Part B
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
POS
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
PPO
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
aetna
Workers Comp
O
456.59
160.72
209.00
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
EPO
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
HMO
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
Medicaid
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
Medicare Part A
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
Medicare Part B
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
POS
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
PPO
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield
Workers Comp
O
456.59
160.72
271.79
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
EPO
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
HMO
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
Medicaid
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
POS
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
PPO
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
blue cross blue shield - medicare advantage
Workers Comp
O
456.59
160.72
271.80
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
EPO
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
HMO
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
Medicaid
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
Medicare Part A
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
Medicare Part B
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
POS
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
PPO
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
humana - medicare advantage
Workers Comp
O
456.59
160.72
160.72
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
EPO
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
HMO
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
Medicaid
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
Medicare Part A
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
Medicare Part B
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
POS
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
PPO
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
tricare
Workers Comp
O
456.59
160.72
161.43
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
EPO
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
HMO
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
Medicaid
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
Medicare Part A
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
Medicare Part B
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
POS
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
PPO
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74240
null
cpt
X-ray of upper digestive tract with single contrast
united healthcare
Workers Comp
O
456.59
160.72
326.14
326.14
273.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
EPO
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
HMO
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
Medicaid
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
Medicare Part A
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
Medicare Part B
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
POS
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
PPO
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
aetna
Workers Comp
O
456.67
124.70
264.87
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
EPO
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
HMO
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
Medicaid
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
Medicare Part A
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
Medicare Part B
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
POS
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
PPO
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield
Workers Comp
O
456.67
124.70
263.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
EPO
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
HMO
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
Medicaid
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
POS
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
PPO
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
blue cross blue shield - medicare advantage
Workers Comp
O
456.67
124.70
242.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
EPO
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
HMO
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
Medicaid
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
Medicare Part A
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
Medicare Part B
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
POS
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
PPO
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
humana - medicare advantage
Workers Comp
O
456.67
124.70
158.13
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
EPO
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
HMO
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
Medicaid
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
Medicare Part A
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
Medicare Part B
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
POS
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
PPO
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
tricare
Workers Comp
O
456.67
124.70
161.43
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
EPO
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
HMO
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
Medicaid
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
Medicare Part A
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
Medicare Part B
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
POS
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
PPO
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
united healthcare
Workers Comp
O
456.67
124.70
326.20
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
EPO
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
HMO
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
Medicaid
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
Medicare Part A
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
Medicare Part B
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
POS
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
PPO
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
va
Workers Comp
O
456.67
124.70
124.70
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
EPO
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
HMO
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
Medicaid
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
Medicare Part A
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
Medicare Part B
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
POS
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
PPO
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74246
null
cpt
X-ray of upper digestive tract with double contrast
webtpa
Workers Comp
O
456.67
124.70
248.32
326.20
190.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
EPO
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
HMO
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
Medicaid
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
Medicare Part A
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
Medicare Part B
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
POS
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
PPO
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74248
null
cpt
Follow-through X-ray of upper digestive tract with multiple serial films
blue cross blue shield - medicare advantage
Workers Comp
O
200.84
89.70
89.70
89.70
120.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
EPO
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
HMO
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
Medicaid
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
Medicare Part A
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
Medicare Part B
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
POS
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
PPO
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
aetna - medicare advantage
Workers Comp
O
449.44
158.13
158.13
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
EPO
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
HMO
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
Medicaid
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
Medicare Part A
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
Medicare Part B
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
POS
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
PPO
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
blue cross blue shield - medicare advantage
Workers Comp
O
449.44
158.13
296.91
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
EPO
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
HMO
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
Medicaid
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
Medicare Part A
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
Medicare Part B
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
POS
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
PPO
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
cigna
Workers Comp
O
449.44
158.13
315.06
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
EPO
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
HMO
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
Medicaid
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
Medicare Part A
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
Medicare Part B
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
POS
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
PPO
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74250
null
cpt
X-ray of upper digestive tract with single contrast and multiple serial films
tricare
Workers Comp
O
449.44
158.13
159.78
315.06
269.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
EPO
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
HMO
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
Medicaid
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
Medicare Part A
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
Medicare Part B
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
POS
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
PPO
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield
Workers Comp
O
630.17
276.59
276.59
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
EPO
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
HMO
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
Medicaid
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
POS
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
PPO
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74270
null
cpt
X-ray of large bowel with contrast
blue cross blue shield - medicare advantage
Workers Comp
O
630.17
276.59
360.90
360.90
378.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
EPO
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
HMO
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
Medicaid
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
Medicare Part A
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
Medicare Part B
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
POS
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
PPO
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield
Workers Comp
O
875.93
158.53
371.40
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
EPO
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
HMO
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
Medicaid
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
POS
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
PPO
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
blue cross blue shield - medicare advantage
Workers Comp
O
875.93
158.53
318.52
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
EPO
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
HMO
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
Medicaid
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
Medicare Part A
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
Medicare Part B
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
POS
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
PPO
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74280
null
cpt
X-ray of large bowel with air contrast
united healthcare - medicare advantage
Workers Comp
O
875.93
158.53
158.53
371.40
525.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
EPO
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
HMO
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
Medicaid
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
Medicare Part A
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
Medicare Part B
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
POS
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
PPO
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
blue cross blue shield - medicare advantage
Workers Comp
I
44893.07
8041.38
8824.87
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
EPO
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
HMO
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
Medicaid
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
Medicare Part A
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
Medicare Part B
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
POS
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
PPO
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
743
null
ms-drg
Hysterectomy
tricare
Workers Comp
I
44893.07
8041.38
8041.38
8824.87
26935.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
EPO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
HMO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
Medicaid
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
Medicare Part A
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
Medicare Part B
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
POS
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
PPO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield
Workers Comp
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
EPO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
HMO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
Medicaid
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
Medicare Part A
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
Medicare Part B
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
POS
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
PPO
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
blue cross blue shield - medicare advantage
Workers Comp
O
950.50
161.43
404.62
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
EPO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
HMO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
Medicaid
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
Medicare Part A
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
Medicare Part B
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
POS
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
PPO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
humana - medicare advantage
Workers Comp
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
EPO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
HMO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
Medicaid
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
Medicare Part A
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
Medicare Part B
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
POS
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
PPO
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74415
null
cpt
Imaging of urinary tract using infusion technique with kidney section filming
tricare
Workers Comp
O
950.50
161.43
161.43
404.62
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
EPO
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
HMO
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
Medicaid
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
Medicare Part A
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
Medicare Part B
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
POS
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
PPO
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield
Workers Comp
O
950.50
230.85
371.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
EPO
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
HMO
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
Medicaid
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
Medicare Part A
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
Medicare Part B
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
POS
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
PPO
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
blue cross blue shield - medicare advantage
Workers Comp
O
950.50
230.85
230.85
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
EPO
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
HMO
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
Medicaid
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
Medicare Part A
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
Medicare Part B
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
POS
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
PPO
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74420
null
cpt
Imaging of urinary tract
humana - medicare advantage
Workers Comp
O
950.50
230.85
326.02
371.02
262.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
EPO
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
HMO
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
Medicaid
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
Medicare Part A
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
Medicare Part B
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
POS
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
PPO
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74430
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder minimum of 3 views
humana - medicare advantage
Workers Comp
O
950.50
338.27
338.27
338.27
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
EPO
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
HMO
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
Medicaid
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
Medicare Part A
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
Medicare Part B
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
POS
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
PPO
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
humana - medicare advantage
Workers Comp
O
950.50
203.81
206.45
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
EPO
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
HMO
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
Medicaid
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
Medicare Part A
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
Medicare Part B
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
POS
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
PPO
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
tricare
Workers Comp
O
950.50
203.81
205.13
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
EPO
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
HMO
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
Medicaid
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
Medicare Part A
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
Medicare Part B
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
POS
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
PPO
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74455
null
cpt
Radiological supervision and interpretation X-ray of urinary bladder and urethra emptying
va
Workers Comp
O
950.50
203.81
203.81
206.45
570.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
EPO
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
HMO
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
Medicaid
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
Medicare Part A
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
Medicare Part B
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
POS
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
PPO
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
74740
null
cpt
Radiological supervision and interpretation X-ray of uterine tubes and ovaries
tricare
Workers Comp
O
1033.97
206.45
206.45
206.45
620.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
EPO
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
HMO
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
Medicaid
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
Medicare Part A
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
Medicare Part B
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
POS
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
PPO
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75571
null
cpt
CT scan of heart with evaluation of blood vessel calcium
blue cross blue shield
Workers Comp
O
52.50
36.40
36.40
36.40
31.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
EPO
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
HMO
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
Medicaid
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
Medicare Part A
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
Medicare Part B
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
POS
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
PPO
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield
Workers Comp
O
9503.90
2246.39
2246.39
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
EPO
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
HMO
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
Medicaid
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
Medicare Part A
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
Medicare Part B
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
POS
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
PPO
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
blue cross blue shield - medicare advantage
Workers Comp
O
9503.90
2246.39
3083.23
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
EPO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
HMO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
Medicaid
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
Medicare Part A
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
Medicare Part B
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
POS
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
PPO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
humana - medicare advantage
Workers Comp
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
EPO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
HMO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
Medicaid
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
Medicare Part A
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
Medicare Part B
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
POS
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
PPO
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
tricare
Workers Comp
O
9503.90
2246.39
2455.02
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
EPO
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
HMO
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
Medicaid
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
Medicare Part A
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
Medicare Part B
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
POS
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
PPO
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75625
null
cpt
Radiological supervision and interpretation X-ray of abdominal aorta
va
Workers Comp
O
9503.90
2246.39
2534.31
3083.23
5702.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
EPO
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
HMO
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
Medicaid
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
Medicare Part A
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
Medicare Part B
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
POS
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
PPO
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
blue cross blue shield
Workers Comp
O
1737.39
158.13
557.59
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
EPO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
HMO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
Medicaid
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
Medicare Part A
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
Medicare Part B
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
POS
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
PPO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
humana - medicare advantage
Workers Comp
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
EPO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
HMO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
Medicaid
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
Medicare Part A
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
Medicare Part B
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
POS
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
PPO
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75635
null
cpt
CT scan of abdominal aorta and both leg arteries with contrast
va
Workers Comp
O
1737.39
158.13
158.13
557.59
1042.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
EPO
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
HMO
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
Medicaid
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
Medicare Part A
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
Medicare Part B
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
POS
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
PPO
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75710
null
cpt
Radiological supervision and interpretation of imaging of artery of one arm or leg
blue cross blue shield
Workers Comp
O
3126.41
841.02
841.02
841.02
1875.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
EPO
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
HMO
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
Medicaid
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
Medicare Part A
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
Medicare Part B
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
POS
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
PPO
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield
Workers Comp
O
6378.60
1299.48
1299.48
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
EPO
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
HMO
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
Medicaid
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
Medicare Part A
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
Medicare Part B
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
POS
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
PPO
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
blue cross blue shield - medicare advantage
Workers Comp
O
6378.60
1299.48
2069.33
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
EPO
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
HMO
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
Medicaid
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
Medicare Part A
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
Medicare Part B
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
POS
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
PPO
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75716
null
cpt
Radiological supervision and interpretation of imaging of arteries of both arms or legs
humana - medicare advantage
Workers Comp
O
6378.60
1299.48
2455.02
2455.02
3827.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
EPO
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
HMO
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
Medicaid
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
Medicare Part A
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
Medicare Part B
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
POS
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
PPO
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
759
null
ms-drg
infections female reproductive system without cc/mcc
blue cross blue shield
Workers Comp
I
18398.32
6831.60
6831.60
6831.60
11038.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
EPO
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
HMO
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
Medicaid
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
POS
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
PPO
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
75989
null
cpt
Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure
blue cross blue shield - medicare advantage
Workers Comp
O
826.95
548.22
548.22
548.22
496.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
EPO
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
HMO
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
POS
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
PPO
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76000
null
cpt
Imaging guidance for procedure up to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
578.76
29.09
29.09
29.09
347.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
EPO
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
HMO
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
Medicaid
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
Medicare Part A
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
Medicare Part B
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
POS
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
PPO
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76080
null
cpt
Imaging for abscess or abnormal drainage tract procedure
humana - medicare advantage
Workers Comp
O
1200.26
427.67
427.67
427.67
720.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
EPO
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
HMO
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
Medicaid
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
Medicare Part A
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
Medicare Part B
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
POS
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
PPO
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield
Workers Comp
O
1173.10
200.55
475.40
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
EPO
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
HMO
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
Medicaid
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
Medicare Part A
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
Medicare Part B
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
POS
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
PPO
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
blue cross blue shield - medicare advantage
Workers Comp
O
1173.10
200.55
200.55
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
EPO
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
HMO
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
Medicaid
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
Medicare Part A
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
Medicare Part B
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
POS
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
PPO
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76098
null
cpt
Imaging of surgical specimen
humana - medicare advantage
Workers Comp
O
1173.10
200.55
1243.48
1243.48
703.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
EPO
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
HMO
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
Medicaid
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
Medicare Part A
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
Medicare Part B
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
POS
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
PPO
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
aetna
Workers Comp
O
464.12
95.47
260.79
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
EPO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
HMO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
Medicaid
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
Medicare Part A
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
Medicare Part B
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
POS
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
PPO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield
Workers Comp
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
EPO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
HMO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
Medicaid
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
Medicare Part A
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
Medicare Part B
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
POS
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
PPO
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
blue cross blue shield - medicare advantage
Workers Comp
O
464.12
95.47
216.32
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
EPO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
HMO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
Medicaid
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
Medicare Part A
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
Medicare Part B
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
POS
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
PPO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
geha
Workers Comp
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
EPO
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
HMO
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
Medicaid
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
Medicare Part A
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
Medicare Part B
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
POS
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
PPO
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana
Workers Comp
O
464.12
95.47
348.09
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
EPO
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
HMO
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
Medicaid
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
Medicare Part A
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
Medicare Part B
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
POS
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
PPO
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
humana - medicare advantage
Workers Comp
O
464.12
95.47
96.51
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
EPO
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
HMO
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
Medicaid
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
Medicare Part A
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
Medicare Part B
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
POS
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
PPO
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
tricare
Workers Comp
O
464.12
95.47
99.29
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
EPO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
HMO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
Medicaid
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
Medicare Part A
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
Medicare Part B
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
POS
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
PPO
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare
Workers Comp
O
464.12
95.47
331.52
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
EPO
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
HMO
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
Medicaid
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
Medicare Part A
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
Medicare Part B
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
POS
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
PPO
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
united healthcare - medicare advantage
Workers Comp
O
464.12
95.47
95.47
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
EPO
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
HMO
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
Medicaid
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
Medicare Part A
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
Medicare Part B
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
POS
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
PPO
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
va
Workers Comp
O
464.12
95.47
96.50
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
EPO
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
HMO
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
Medicaid
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
Medicare Part A
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
Medicare Part B
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
POS
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
PPO
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76536
null
cpt
Ultrasound of head and neck
webtpa
Workers Comp
O
464.12
95.47
309.41
348.09
278.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
EPO
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
HMO
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
Medicaid
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
Medicare Part A
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
Medicare Part B
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
POS
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
PPO
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76604
null
cpt
Ultrasound of chest
blue cross blue shield
Workers Comp
O
521.52
282.79
282.79
282.79
312.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
EPO
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
HMO
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
Medicaid
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
Medicare Part A
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
Medicare Part B
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
POS
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
PPO
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna
Workers Comp
O
288.26
48.27
167.19
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
EPO
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
HMO
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
Medicaid
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
Medicare Part A
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
Medicare Part B
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
POS
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
PPO
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
aetna - medicare advantage
Workers Comp
O
288.26
48.27
71.65
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
EPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
HMO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
Medicaid
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
Medicare Part A
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
Medicare Part B
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
POS
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
PPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield
Workers Comp
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
EPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
HMO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
Medicaid
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
Medicare Part A
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
Medicare Part B
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
POS
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
PPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
blue cross blue shield - medicare advantage
Workers Comp
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
EPO
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
HMO
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
Medicaid
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
Medicare Part A
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
Medicare Part B
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
POS
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
PPO
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
cigna
Workers Comp
O
288.26
48.27
203.98
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
EPO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
HMO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
Medicaid
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
Medicare Part A
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
Medicare Part B
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
POS
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
PPO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
geha
Workers Comp
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
EPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
HMO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
Medicaid
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
Medicare Part A
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
Medicare Part B
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
POS
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
PPO
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
healthchoice
Workers Comp
O
288.26
48.27
216.32
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
EPO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
HMO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
Medicaid
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
Medicare Part A
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
Medicare Part B
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
POS
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
PPO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
humana - medicare advantage
Workers Comp
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
EPO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
HMO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
Medicaid
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
Medicare Part A
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
Medicare Part B
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
POS
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
PPO
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
tricare
Workers Comp
O
288.26
48.27
70.70
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
EPO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
HMO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
Medicaid
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
Medicare Part A
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
Medicare Part B
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
POS
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
PPO
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare
Workers Comp
O
288.26
48.27
205.91
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
EPO
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
HMO
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
Medicaid
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
Medicare Part A
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
Medicare Part B
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
POS
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
PPO
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
united healthcare - medicare advantage
Workers Comp
O
288.26
48.27
69.29
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
EPO
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
HMO
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
Medicaid
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
Medicare Part A
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
Medicare Part B
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
POS
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
PPO
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
va
Workers Comp
O
288.26
48.27
48.27
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
EPO
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
HMO
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
Medicaid
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
Medicare Part A
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
Medicare Part B
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
POS
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
PPO
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76642
null
cpt
Ultrasound of one breast limited
webtpa
Workers Comp
O
288.26
48.27
196.24
216.32
172.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
EPO
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
HMO
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
Medicaid
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
Medicare Part A
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
Medicare Part B
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
POS
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
PPO
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna
Workers Comp
O
915.99
96.50
531.27
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
EPO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
HMO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
Medicaid
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
Medicare Part A
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
Medicare Part B
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
POS
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
PPO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
aetna - medicare advantage
Workers Comp
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
EPO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
HMO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
Medicaid
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
Medicare Part A
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
Medicare Part B
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
POS
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
PPO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield
Workers Comp
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
EPO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
HMO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
Medicaid
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
Medicare Part A
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
Medicare Part B
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
POS
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
PPO
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
blue cross blue shield - medicare advantage
Workers Comp
O
915.99
96.50
216.32
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
EPO
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
HMO
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
Medicaid
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
Medicare Part A
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
Medicare Part B
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
POS
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
PPO
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
cigna
Workers Comp
O
915.99
96.50
611.54
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
EPO
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
HMO
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
Medicaid
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
Medicare Part A
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
Medicare Part B
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
POS
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
PPO
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
humana - medicare advantage
Workers Comp
O
915.99
96.50
97.90
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
EPO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
HMO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
Medicaid
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
Medicare Part A
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
Medicare Part B
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
POS
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
PPO
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
tricare
Workers Comp
O
915.99
96.50
99.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
EPO
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
HMO
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
Medicaid
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
Medicare Part A
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
Medicare Part B
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
POS
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
PPO
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
united healthcare
Workers Comp
O
915.99
96.50
654.29
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
EPO
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
HMO
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
Medicaid
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
Medicare Part A
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
Medicare Part B
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
POS
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
PPO
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
va
Workers Comp
O
915.99
96.50
96.50
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
EPO
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
HMO
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
Medicaid
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
Medicare Part A
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
Medicare Part B
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
POS
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
PPO
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76700
null
cpt
Ultrasound of abdomen
webtpa
Workers Comp
O
915.99
96.50
641.19
654.29
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
EPO
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
HMO
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
Medicaid
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
Medicare Part A
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
Medicare Part B
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
POS
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
PPO
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna
Workers Comp
O
670.02
96.50
404.83
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
EPO
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
HMO
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
Medicaid
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
Medicare Part A
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
Medicare Part B
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
POS
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
PPO
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
aetna - medicare advantage
Workers Comp
O
670.02
96.50
97.90
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
EPO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
HMO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
Medicaid
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
Medicare Part A
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
Medicare Part B
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
POS
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
PPO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield
Workers Comp
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
EPO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
HMO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
Medicaid
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
Medicare Part A
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
Medicare Part B
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
POS
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
PPO
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
blue cross blue shield - medicare advantage
Workers Comp
O
670.02
96.50
216.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
EPO
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
HMO
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
Medicaid
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
Medicare Part A
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
Medicare Part B
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
POS
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
PPO
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
cigna
Workers Comp
O
670.02
96.50
447.32
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
EPO
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
HMO
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
Medicaid
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
Medicare Part A
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
Medicare Part B
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
POS
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
PPO
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
humana - medicare advantage
Workers Comp
O
670.02
96.50
96.51
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
EPO
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
HMO
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
Medicaid
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
Medicare Part A
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
Medicare Part B
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
POS
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
PPO
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
tricare
Workers Comp
O
670.02
96.50
99.29
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
EPO
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
HMO
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
Medicaid
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
Medicare Part A
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
Medicare Part B
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
POS
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
PPO
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
united healthcare
Workers Comp
O
670.02
96.50
478.59
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
EPO
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
HMO
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
Medicaid
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
Medicare Part A
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
Medicare Part B
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
POS
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
PPO
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
va
Workers Comp
O
670.02
96.50
96.50
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
EPO
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
HMO
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
Medicaid
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
Medicare Part A
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
Medicare Part B
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
POS
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
PPO
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76705
null
cpt
Ultrasound of abdomen limited
webtpa
Workers Comp
O
670.02
96.50
446.68
478.59
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
EPO
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
HMO
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
Medicaid
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
Medicare Part A
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
Medicare Part B
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
POS
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
PPO
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
aetna
Workers Comp
O
705.64
96.50
409.27
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
EPO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
HMO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
Medicaid
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
Medicare Part A
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
Medicare Part B
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
POS
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
PPO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield
Workers Comp
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
EPO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
HMO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
Medicaid
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
Medicare Part A
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
Medicare Part B
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
POS
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
PPO
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
blue cross blue shield - medicare advantage
Workers Comp
O
705.64
96.50
216.32
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
EPO
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
HMO
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
Medicaid
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
Medicare Part A
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
Medicare Part B
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
POS
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
PPO
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
cigna
Workers Comp
O
705.64
96.50
437.70
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
EPO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
HMO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
Medicaid
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
Medicare Part A
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
Medicare Part B
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
POS
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
PPO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
humana - medicare advantage
Workers Comp
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
EPO
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
HMO
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
Medicaid
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
Medicare Part A
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
Medicare Part B
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
POS
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
PPO
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
tricare
Workers Comp
O
705.64
96.50
96.51
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
EPO
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
HMO
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
Medicaid
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
Medicare Part A
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
Medicare Part B
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
POS
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
PPO
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare
Workers Comp
O
705.64
96.50
529.23
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
EPO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
HMO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
Medicaid
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
Medicare Part A
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
Medicare Part B
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
POS
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
PPO
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
united healthcare - medicare advantage
Workers Comp
O
705.64
96.50
99.29
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
EPO
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
HMO
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
Medicaid
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
Medicare Part A
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
Medicare Part B
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
POS
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
PPO
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
va
Workers Comp
O
705.64
96.50
96.50
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
EPO
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
HMO
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
Medicaid
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
Medicare Part A
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
Medicare Part B
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
POS
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
PPO
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76770
null
cpt
Ultrasound behind abdominal cavity
webtpa
Workers Comp
O
705.64
96.50
470.43
529.23
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
EPO
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
HMO
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
Medicaid
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
Medicare Part A
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
Medicare Part B
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
POS
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
PPO
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
blue cross blue shield
Workers Comp
O
367.29
96.50
216.32
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
EPO
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
HMO
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
Medicaid
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
Medicare Part A
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
Medicare Part B
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
POS
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
PPO
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
humana - medicare advantage
Workers Comp
O
367.29
96.50
99.29
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
EPO
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
HMO
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
Medicaid
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
Medicare Part A
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
Medicare Part B
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
POS
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
PPO
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
united healthcare
Workers Comp
O
367.29
96.50
275.47
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
EPO
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
HMO
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
Medicaid
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
Medicare Part A
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
Medicare Part B
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
POS
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
PPO
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76775
null
cpt
Ultrasound behind abdominal cavity limited
va
Workers Comp
O
367.29
96.50
96.50
275.47
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
EPO
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
HMO
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
Medicaid
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
Medicare Part A
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
Medicare Part B
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
POS
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
PPO
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield
Workers Comp
I
13507.53
3283.96
10841.57
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
EPO
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
HMO
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
Medicaid
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
Medicare Part A
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
Medicare Part B
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
POS
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
PPO
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
blue cross blue shield - medicare advantage
Workers Comp
I
13507.53
3283.96
9311.08
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
EPO
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
HMO
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
Medicaid
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
Medicare Part A
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
Medicare Part B
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
POS
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
PPO
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
tricare
Workers Comp
I
13507.53
3283.96
3283.96
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
EPO
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
HMO
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
Medicaid
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
Medicare Part A
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
Medicare Part B
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
POS
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
PPO
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
768
null
ms-drg
vaginal delivery with o.r. procedures except sterilization and/or d&c
webtpa
Workers Comp
I
13507.53
3283.96
25999.71
25999.71
8104.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
EPO
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
HMO
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
Medicaid
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
Medicare Part A
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
Medicare Part B
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
POS
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
PPO
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
aetna
Workers Comp
O
357.27
96.50
200.75
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
EPO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
HMO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
Medicaid
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
Medicare Part A
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
Medicare Part B
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
POS
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
PPO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield
Workers Comp
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
EPO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
HMO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
Medicaid
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
Medicare Part A
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
Medicare Part B
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
POS
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
PPO
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
blue cross blue shield - medicare advantage
Workers Comp
O
357.27
96.50
229.19
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
EPO
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
HMO
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
Medicaid
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
Medicare Part A
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
Medicare Part B
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
POS
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
PPO
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
cigna
Workers Comp
O
357.27
96.50
252.81
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
EPO
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
HMO
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
Medicaid
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
Medicare Part A
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
Medicare Part B
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
POS
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
PPO
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana
Workers Comp
O
357.27
96.50
267.95
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
EPO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
HMO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
Medicaid
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
Medicare Part A
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
Medicare Part B
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
POS
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
PPO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
humana - medicare advantage
Workers Comp
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
EPO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
HMO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
Medicaid
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
Medicare Part A
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
Medicare Part B
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
POS
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
PPO
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
tricare
Workers Comp
O
357.27
96.50
99.29
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
EPO
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
HMO
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
Medicaid
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
Medicare Part A
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
Medicare Part B
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
POS
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
PPO
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
united healthcare
Workers Comp
O
357.27
96.50
255.20
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
EPO
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
HMO
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
Medicaid
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
Medicare Part A
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
Medicare Part B
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
POS
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
PPO
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
va
Workers Comp
O
357.27
96.50
96.50
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
EPO
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
HMO
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
Medicaid
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
Medicare Part A
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
Medicare Part B
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
POS
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
PPO
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76801
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus
webtpa
Workers Comp
O
357.27
96.50
238.18
267.95
118.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
EPO
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
HMO
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
Medicaid
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
Medicare Part A
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
Medicare Part B
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
POS
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
PPO
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76802
null
cpt
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)
blue cross blue shield
Workers Comp
O
113.00
84.12
84.12
84.12
67.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
EPO
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
HMO
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
Medicaid
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
Medicare Part A
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
Medicare Part B
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
POS
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
PPO
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
aetna
Workers Comp
O
417.37
49.86
322.10
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
EPO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
HMO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
Medicaid
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
Medicare Part A
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
Medicare Part B
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
POS
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
PPO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield
Workers Comp
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
EPO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
HMO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
Medicaid
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
Medicare Part A
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
Medicare Part B
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
POS
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
PPO
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
blue cross blue shield - medicare advantage
Workers Comp
O
417.37
49.86
229.19
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
EPO
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
HMO
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
Medicaid
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
Medicare Part A
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
Medicare Part B
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
POS
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
PPO
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
cigna
Workers Comp
O
417.37
49.86
278.65
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
EPO
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
HMO
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
Medicaid
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
Medicare Part A
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
Medicare Part B
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
POS
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
PPO
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
healthchoice
Workers Comp
O
417.37
49.86
49.86
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
EPO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
HMO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
Medicaid
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
Medicare Part A
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
Medicare Part B
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
POS
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
PPO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
humana - medicare advantage
Workers Comp
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
EPO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
HMO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
Medicaid
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
Medicare Part A
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
Medicare Part B
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
POS
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
PPO
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
tricare
Workers Comp
O
417.37
49.86
99.29
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
EPO
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
HMO
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
Medicaid
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
Medicare Part A
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
Medicare Part B
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
POS
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
PPO
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
united healthcare
Workers Comp
O
417.37
49.86
298.13
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
EPO
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
HMO
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
Medicaid
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
Medicare Part A
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
Medicare Part B
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
POS
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
PPO
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
va
Workers Comp
O
417.37
49.86
96.50
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
EPO
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
HMO
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
Medicaid
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
Medicare Part A
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
Medicare Part B
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
POS
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
PPO
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76805
null
cpt
Pregnacy Ultrasound > 14 weeks
webtpa
Workers Comp
O
417.37
49.86
278.25
322.10
119.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
EPO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
HMO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
Medicaid
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
Medicare Part A
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
Medicare Part B
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
POS
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
PPO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
aetna
Workers Comp
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
EPO
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
HMO
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
Medicaid
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
Medicare Part A
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
Medicare Part B
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
POS
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
PPO
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield
Workers Comp
O
576.53
96.50
160.06
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
EPO
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
HMO
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
Medicaid
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
Medicare Part A
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
Medicare Part B
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
POS
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
PPO
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
blue cross blue shield - medicare advantage
Workers Comp
O
576.53
96.50
161.24
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
EPO
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
HMO
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
Medicaid
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
Medicare Part A
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
Medicare Part B
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
POS
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
PPO
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
cigna
Workers Comp
O
576.53
96.50
384.91
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
EPO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
HMO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
Medicaid
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
Medicare Part A
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
Medicare Part B
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
POS
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
PPO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
tricare
Workers Comp
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
EPO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
HMO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
Medicaid
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
Medicare Part A
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
Medicare Part B
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
POS
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
PPO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
united healthcare
Workers Comp
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
EPO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
HMO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
Medicaid
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
Medicare Part A
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
Medicare Part B
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
POS
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
PPO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76815
null
cpt
Ultrasound of pregnant uterus 1 or more fetus(es)
va
Workers Comp
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
EPO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
HMO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
Medicaid
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
Medicare Part A
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
Medicare Part B
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
POS
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
PPO
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
aetna
Workers Comp
O
576.53
96.50
348.34
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
EPO
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
HMO
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
Medicaid
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
Medicare Part A
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
Medicare Part B
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
POS
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
PPO
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield
Workers Comp
O
576.53
96.50
205.88
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
EPO
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
HMO
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
Medicaid
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
Medicare Part A
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
Medicare Part B
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
POS
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
PPO
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
blue cross blue shield - medicare advantage
Workers Comp
O
576.53
96.50
229.19
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
EPO
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
HMO
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
Medicaid
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
Medicare Part A
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
Medicare Part B
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
POS
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
PPO
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
healthchoice
Workers Comp
O
576.53
96.50
204.12
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
EPO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
HMO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
Medicaid
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
Medicare Part A
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
Medicare Part B
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
POS
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
PPO
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
tricare
Workers Comp
O
576.53
96.50
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
EPO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
HMO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
Medicaid
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
Medicare Part A
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
Medicare Part B
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
POS
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
PPO
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
united healthcare
Workers Comp
O
576.53
96.50
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
EPO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
HMO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
Medicaid
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
Medicare Part A
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
Medicare Part B
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
POS
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
PPO
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
va
Workers Comp
O
576.53
96.50
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
EPO
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
HMO
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
Medicaid
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
Medicare Part A
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
Medicare Part B
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
POS
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
PPO
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76816
null
cpt
Ultrasound re-evaluation of pregnant uterus per fetus
webtpa
Workers Comp
O
576.53
96.50
393.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
EPO
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
HMO
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
Medicaid
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
Medicare Part A
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
Medicare Part B
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
POS
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
PPO
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
aetna
Workers Comp
O
576.53
96.51
341.37
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
EPO
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
HMO
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
Medicaid
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
Medicare Part A
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
Medicare Part B
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
POS
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
PPO
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield
Workers Comp
O
576.53
96.51
140.18
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
EPO
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
HMO
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
Medicaid
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
Medicare Part A
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
Medicare Part B
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
POS
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
PPO
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
blue cross blue shield - medicare advantage
Workers Comp
O
576.53
96.51
217.44
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
EPO
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
HMO
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
Medicaid
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
Medicare Part A
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
Medicare Part B
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
POS
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
PPO
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
cigna
Workers Comp
O
576.53
96.51
384.91
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
EPO
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
HMO
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
Medicaid
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
Medicare Part A
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
Medicare Part B
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
POS
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
PPO
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
humana - medicare advantage
Workers Comp
O
576.53
96.51
96.51
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
EPO
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
HMO
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
Medicaid
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
Medicare Part A
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
Medicare Part B
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
POS
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
PPO
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
tricare
Workers Comp
O
576.53
96.51
98.16
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
EPO
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
HMO
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
Medicaid
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
Medicare Part A
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
Medicare Part B
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
POS
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
PPO
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
united healthcare
Workers Comp
O
576.53
96.51
411.81
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
EPO
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
HMO
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
Medicaid
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
Medicare Part A
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
Medicare Part B
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
POS
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
PPO
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76817
null
cpt
Vaginal ultrasound of pregnant uterus
webtpa
Workers Comp
O
576.53
96.51
384.36
411.81
159.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
EPO
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
HMO
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
Medicaid
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
Medicare Part A
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
Medicare Part B
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
POS
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
PPO
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
aetna
Workers Comp
O
773.80
99.29
456.54
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
EPO
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
HMO
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
Medicaid
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
Medicare Part A
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
Medicare Part B
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
POS
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
PPO
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76818
null
cpt
Ultrasound and monitoring of heart of fetus
tricare
Workers Comp
O
773.80
99.29
99.29
456.54
464.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
EPO
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
HMO
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
Medicaid
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
Medicare Part A
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
Medicare Part B
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
POS
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
PPO
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
aetna
Workers Comp
O
576.53
35.77
334.39
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
EPO
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
HMO
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
Medicaid
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
Medicare Part A
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
Medicare Part B
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
POS
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
PPO
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield
Workers Comp
O
576.53
35.77
164.42
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
EPO
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
HMO
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
Medicaid
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
Medicare Part A
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
Medicare Part B
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
POS
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
PPO
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
blue cross blue shield - medicare advantage
Workers Comp
O
576.53
35.77
170.26
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
EPO
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
HMO
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
Medicaid
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
Medicare Part A
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
Medicare Part B
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
POS
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
PPO
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
cigna
Workers Comp
O
576.53
35.77
407.97
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
EPO
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
HMO
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
Medicaid
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
Medicare Part A
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
Medicare Part B
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
POS
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
PPO
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
healthchoice
Workers Comp
O
576.53
35.77
35.77
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
EPO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
HMO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
Medicaid
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
Medicare Part A
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
Medicare Part B
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
POS
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
PPO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
humana - medicare advantage
Workers Comp
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
EPO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
HMO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
Medicaid
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
Medicare Part A
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
Medicare Part B
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
POS
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
PPO
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
tricare
Workers Comp
O
576.53
35.77
99.29
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
EPO
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
HMO
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
Medicaid
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
Medicare Part A
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
Medicare Part B
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
POS
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
PPO
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
united healthcare
Workers Comp
O
576.53
35.77
411.81
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
EPO
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
HMO
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
Medicaid
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
Medicare Part A
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
Medicare Part B
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
POS
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
PPO
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
va
Workers Comp
O
576.53
35.77
96.50
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
EPO
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
HMO
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
Medicaid
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
Medicare Part A
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
Medicare Part B
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
POS
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
PPO
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76819
null
cpt
Ultrasound of fetus
webtpa
Workers Comp
O
576.53
35.77
247.09
411.81
345.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
EPO
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
HMO
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
Medicaid
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
Medicare Part A
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
Medicare Part B
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
POS
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
PPO
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
blue cross blue shield
Workers Comp
O
230.39
77.84
77.84
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
EPO
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
HMO
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
Medicaid
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
Medicare Part A
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
Medicare Part B
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
POS
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
PPO
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
tricare
Workers Comp
O
230.39
77.84
230.39
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
EPO
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
HMO
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
Medicaid
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
Medicare Part A
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
Medicare Part B
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
POS
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
PPO
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76820
null
cpt
Ultrasound of fetal umbilical artery flow rate
united healthcare
Workers Comp
O
230.39
77.84
172.79
230.39
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
EPO
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
HMO
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
Medicaid
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
Medicare Part A
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
Medicare Part B
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
POS
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
PPO
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
aetna
Workers Comp
O
750.16
96.50
435.09
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
EPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
HMO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
Medicaid
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
Medicare Part A
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
Medicare Part B
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
POS
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
PPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield
Workers Comp
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
EPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
HMO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
Medicaid
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
Medicare Part A
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
Medicare Part B
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
POS
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
PPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
blue cross blue shield - medicare advantage
Workers Comp
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
EPO
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
HMO
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
Medicaid
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
Medicare Part A
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
Medicare Part B
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
POS
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
PPO
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
cigna
Workers Comp
O
750.16
96.50
530.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
EPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
HMO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
Medicaid
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
Medicare Part A
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
Medicare Part B
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
POS
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
PPO
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
healthchoice
Workers Comp
O
750.16
96.50
216.32
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
EPO
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
HMO
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
Medicaid
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
Medicare Part A
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
Medicare Part B
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
POS
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
PPO
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
humana - medicare advantage
Workers Comp
O
750.16
96.50
96.88
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
EPO
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
HMO
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
Medicaid
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
Medicare Part A
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
Medicare Part B
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
POS
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
PPO
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
tricare
Workers Comp
O
750.16
96.50
98.16
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
EPO
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
HMO
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
Medicaid
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
Medicare Part A
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
Medicare Part B
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
POS
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
PPO
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
united healthcare
Workers Comp
O
750.16
96.50
535.83
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
EPO
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
HMO
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
Medicaid
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
Medicare Part A
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
Medicare Part B
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
POS
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
PPO
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
va
Workers Comp
O
750.16
96.50
96.50
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
EPO
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
HMO
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
Medicaid
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
Medicare Part A
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
Medicare Part B
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
POS
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
PPO
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76830
null
cpt
Pelivic ultrasound
webtpa
Workers Comp
O
750.16
96.50
500.11
535.83
117.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
EPO
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
HMO
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
Medicaid
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
Medicare Part A
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
Medicare Part B
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
POS
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
PPO
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
blue cross blue shield - medicare advantage
Workers Comp
O
615.48
96.50
254.11
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
EPO
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
HMO
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
Medicaid
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
Medicare Part A
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
Medicare Part B
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
POS
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
PPO
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
va
Workers Comp
O
615.48
96.50
96.50
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
EPO
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
HMO
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
Medicaid
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
Medicare Part A
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
Medicare Part B
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
POS
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
PPO
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76856
null
cpt
Ultrasound of pelvis complete not pregnancy related
webtpa
Workers Comp
O
615.48
96.50
430.84
430.84
369.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
EPO
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
HMO
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
Medicaid
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
Medicare Part A
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
Medicare Part B
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
POS
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
PPO
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
aetna
Workers Comp
O
498.62
95.08
289.20
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
EPO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
HMO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
Medicaid
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
Medicare Part A
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
Medicare Part B
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
POS
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
PPO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield
Workers Comp
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
EPO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
HMO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
Medicaid
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
Medicare Part A
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
Medicare Part B
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
POS
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
PPO
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
blue cross blue shield - medicare advantage
Workers Comp
O
498.62
95.08
216.32
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
EPO
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
HMO
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
Medicaid
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
Medicare Part A
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
Medicare Part B
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
POS
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
PPO
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
humana - medicare advantage
Workers Comp
O
498.62
95.08
96.51
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
EPO
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
HMO
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
Medicaid
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
Medicare Part A
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
Medicare Part B
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
POS
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
PPO
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
tricare
Workers Comp
O
498.62
95.08
99.29
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
EPO
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
HMO
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
Medicaid
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
Medicare Part A
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
Medicare Part B
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
POS
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
PPO
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare
Workers Comp
O
498.62
95.08
356.16
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
EPO
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
HMO
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
Medicaid
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
Medicare Part A
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
Medicare Part B
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
POS
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
PPO
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
united healthcare - medicare advantage
Workers Comp
O
498.62
95.08
95.08
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
EPO
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
HMO
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
Medicaid
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
Medicare Part A
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
Medicare Part B
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
POS
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
PPO
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
va
Workers Comp
O
498.62
95.08
96.50
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
EPO
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
HMO
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
Medicaid
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
Medicare Part A
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
Medicare Part B
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
POS
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
PPO
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76870
null
cpt
Ultrasound of scrotum
webtpa
Workers Comp
O
498.62
95.08
340.73
356.16
299.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
EPO
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
HMO
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
Medicaid
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
Medicare Part A
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
Medicare Part B
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
POS
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
PPO
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
aetna
Workers Comp
O
358.38
99.29
201.38
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
EPO
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
HMO
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
Medicaid
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
Medicare Part A
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
Medicare Part B
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
POS
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
PPO
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield
Workers Comp
O
358.38
99.29
216.32
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
EPO
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
HMO
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
Medicaid
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
Medicare Part A
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
Medicare Part B
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
POS
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
PPO
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
blue cross blue shield - medicare advantage
Workers Comp
O
358.38
99.29
178.86
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
EPO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
HMO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
Medicaid
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
Medicare Part A
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
Medicare Part B
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
POS
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
PPO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
humana - medicare advantage
Workers Comp
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
EPO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
HMO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
Medicaid
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
Medicare Part A
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
Medicare Part B
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
POS
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
PPO
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
tricare
Workers Comp
O
358.38
99.29
99.29
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
EPO
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
HMO
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
Medicaid
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
Medicare Part A
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
Medicare Part B
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
POS
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
PPO
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76881
null
cpt
Complete ultrasound of arm or leg
webtpa
Workers Comp
O
358.38
99.29
238.92
238.92
215.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
EPO
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
HMO
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
Medicaid
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
Medicare Part A
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
Medicare Part B
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
POS
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
PPO
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76882
null
cpt
Partial ultrasound of joint or other non-blood vessel structure of arm or leg
blue cross blue shield
Workers Comp
O
230.39
216.32
216.32
216.32
138.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
EPO
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
HMO
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
Medicaid
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
Medicare Part A
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
Medicare Part B
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
POS
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
PPO
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
blue cross blue shield
Workers Comp
I
33550.94
6011.29
14158.39
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
EPO
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
HMO
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
Medicaid
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
Medicare Part A
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
Medicare Part B
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
POS
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
PPO
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
tricare
Workers Comp
I
33550.94
6011.29
8157.44
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
EPO
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
HMO
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
Medicaid
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
Medicare Part A
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
Medicare Part B
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
POS
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
PPO
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
769
null
ms-drg
postpartum and post abortion diagnoses with o.r. procedures
va
Workers Comp
I
33550.94
6011.29
6011.29
14158.39
20130.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
EPO
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
HMO
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
Medicaid
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
Medicare Part A
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
Medicare Part B
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
POS
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
PPO
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield
Workers Comp
O
614.66
298.40
298.40
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
EPO
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
HMO
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
Medicaid
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
Medicare Part A
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
Medicare Part B
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
POS
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
PPO
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76937
null
cpt
Ultrasound guidance for accessing into blood vessel
blue cross blue shield - medicare advantage
Workers Comp
O
614.66
298.40
449.79
449.79
169.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
EPO
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
HMO
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
Medicaid
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
Medicare Part A
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
Medicare Part B
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
POS
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
PPO
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield
Workers Comp
O
224.82
143.26
180.82
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
EPO
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
HMO
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
Medicaid
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
Medicare Part A
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
Medicare Part B
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
POS
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
PPO
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
blue cross blue shield - medicare advantage
Workers Comp
O
224.82
143.26
143.26
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
EPO
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
HMO
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
Medicaid
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
Medicare Part A
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
Medicare Part B
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
POS
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
PPO
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76942
null
cpt
Ultrasonic guidance imaging supervision and interpretation for insertion of needle
united healthcare
Workers Comp
O
224.82
143.26
160.58
180.82
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
EPO
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
HMO
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
Medicaid
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
Medicare Part A
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
Medicare Part B
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
POS
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
PPO
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
aetna
Workers Comp
O
224.82
70.70
130.40
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
EPO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
HMO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
Medicaid
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
Medicare Part A
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
Medicare Part B
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
POS
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
PPO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield
Workers Comp
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
EPO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
HMO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
Medicaid
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
POS
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
PPO
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
blue cross blue shield - medicare advantage
Workers Comp
O
224.82
70.70
216.32
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
EPO
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
HMO
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
Medicaid
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
Medicare Part A
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
Medicare Part B
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
POS
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
PPO
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
humana - medicare advantage
Workers Comp
O
224.82
70.70
70.70
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
EPO
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
HMO
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
Medicaid
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
Medicare Part A
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
Medicare Part B
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
POS
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
PPO
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
76999
null
cpt
Ultrasound procedure
united healthcare
Workers Comp
O
224.82
70.70
160.59
216.32
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
EPO
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
HMO
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
Medicaid
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
Medicare Part A
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
Medicare Part B
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
POS
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
PPO
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
770
null
ms-drg
abortion with d&c aspiration curettage or hysterotomy
tricare
Workers Comp
I
23466.85
4253.56
4253.56
4253.56
14080.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
EPO
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
HMO
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
Medicaid
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
Medicare Part A
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
Medicare Part B
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
POS
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
PPO
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
aetna
Workers Comp
O
754.61
190.86
424.02
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
EPO
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
HMO
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
Medicaid
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
Medicare Part A
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
Medicare Part B
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
POS
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
PPO
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield
Workers Comp
O
754.61
190.86
226.34
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
EPO
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
HMO
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
Medicaid
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
Medicare Part A
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
Medicare Part B
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
POS
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
PPO
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77001
null
cpt
Fluoroscopic guidance for insertion replacement or removal of central venous access device
blue cross blue shield - medicare advantage
Workers Comp
O
754.61
190.86
190.86
424.02
452.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
EPO
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
HMO
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
Medicaid
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
Medicare Part A
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
Medicare Part B
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
POS
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
PPO
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield
Workers Comp
O
1622.75
439.12
551.42
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
EPO
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
HMO
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
Medicaid
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
Medicare Part A
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
Medicare Part B
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
POS
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
PPO
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77002
null
cpt
Fluoroscopic guidance for insertion of needle
blue cross blue shield - medicare advantage
Workers Comp
O
1622.75
439.12
439.12
551.42
973.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
EPO
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
HMO
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
Medicaid
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
Medicare Part A
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
Medicare Part B
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
POS
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
PPO
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
blue cross blue shield
Workers Comp
O
10041.58
3800.12
3800.12
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
EPO
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
HMO
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
Medicaid
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
Medicare Part A
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
Medicare Part B
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
POS
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
PPO
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77021
null
cpt
Radiological supervision and interpretation of MRI guidance for insertion of needle
tricare
Workers Comp
O
10041.58
3800.12
4639.61
4639.61
6024.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
EPO
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
HMO
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
Medicaid
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
Medicare Part A
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
Medicare Part B
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
POS
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
PPO
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield
Workers Comp
O
2840.37
928.12
1066.50
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
EPO
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
HMO
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
Medicaid
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
Medicare Part A
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
Medicare Part B
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
POS
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
PPO
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77049
null
cpt
MRI of both breasts with and without contrast
blue cross blue shield - medicare advantage
Workers Comp
O
2840.37
928.12
928.12
1066.50
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
EPO
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
HMO
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
Medicaid
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
Medicare Part A
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
Medicare Part B
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
POS
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
PPO
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna
Workers Comp
O
173.62
22.38
100.70
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
EPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
HMO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
Medicaid
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
Medicare Part A
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
Medicare Part B
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
POS
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
PPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
aetna - medicare advantage
Workers Comp
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
EPO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
HMO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
Medicaid
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
Medicare Part A
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
Medicare Part B
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
POS
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
PPO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield
Workers Comp
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
EPO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
HMO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
Medicaid
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
Medicare Part A
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
Medicare Part B
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
POS
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
PPO
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
blue cross blue shield - medicare advantage
Workers Comp
O
173.62
22.38
167.23
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
EPO
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
HMO
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
Medicaid
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
Medicare Part A
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
Medicare Part B
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
POS
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
PPO
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
cigna
Workers Comp
O
173.62
22.38
115.92
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
EPO
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
HMO
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
Medicaid
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
Medicare Part A
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
Medicare Part B
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
POS
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
PPO
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
humana - medicare advantage
Workers Comp
O
173.62
22.38
22.44
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
EPO
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
HMO
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
Medicaid
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
Medicare Part A
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
Medicare Part B
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
POS
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
PPO
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
medica
Workers Comp
O
173.62
22.38
64.24
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
EPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
HMO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
Medicaid
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
Medicare Part A
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
Medicare Part B
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
POS
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
PPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
tricare
Workers Comp
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
EPO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
HMO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
Medicaid
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
Medicare Part A
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
Medicare Part B
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
POS
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
PPO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare
Workers Comp
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
EPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
HMO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
Medicaid
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
Medicare Part A
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
Medicare Part B
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
POS
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
PPO
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
united healthcare - medicare advantage
Workers Comp
O
173.62
22.38
22.38
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
EPO
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
HMO
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
Medicaid
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
Medicare Part A
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
Medicare Part B
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
POS
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
PPO
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
va
Workers Comp
O
173.62
22.38
165.36
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
EPO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
HMO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
Medicaid
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
Medicare Part A
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
Medicare Part B
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
POS
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
PPO
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77063
null
cpt
Screening digital tomography of both breasts
worker comp
Workers Comp
O
173.62
22.38
124.02
167.23
104.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
EPO
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
HMO
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
Medicaid
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
Medicare Part A
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
Medicare Part B
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
POS
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
PPO
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna
Workers Comp
O
255.99
80.51
148.47
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
EPO
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
HMO
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
Medicaid
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
Medicare Part A
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
Medicare Part B
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
POS
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
PPO
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
aetna - medicare advantage
Workers Comp
O
255.99
80.51
82.59
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
EPO
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
HMO
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
Medicaid
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
Medicare Part A
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
Medicare Part B
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
POS
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
PPO
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield
Workers Comp
O
255.99
80.51
197.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
EPO
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
HMO
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
Medicaid
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
Medicare Part A
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
Medicare Part B
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
POS
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
PPO
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
blue cross blue shield - medicare advantage
Workers Comp
O
255.99
80.51
145.92
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
EPO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
HMO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
Medicaid
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
Medicare Part A
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
Medicare Part B
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
POS
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
PPO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
humana - medicare advantage
Workers Comp
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
EPO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
HMO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
Medicaid
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
Medicare Part A
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
Medicare Part B
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
POS
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
PPO
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
tricare
Workers Comp
O
255.99
80.51
83.77
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
EPO
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
HMO
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
Medicaid
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
Medicare Part A
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
Medicare Part B
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
POS
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
PPO
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare
Workers Comp
O
255.99
80.51
187.42
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
EPO
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
HMO
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
Medicaid
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
Medicare Part A
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
Medicare Part B
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
POS
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
PPO
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
united healthcare - medicare advantage
Workers Comp
O
255.99
80.51
82.10
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
EPO
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
HMO
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
Medicaid
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
Medicare Part A
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
Medicare Part B
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
POS
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
PPO
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
va
Workers Comp
O
255.99
80.51
80.51
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
EPO
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
HMO
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
Medicaid
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
Medicare Part A
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
Medicare Part B
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
POS
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
PPO
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77065
null
cpt
Mammography of one breast
webtpa
Workers Comp
O
255.99
80.51
174.27
197.77
98.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
EPO
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
HMO
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
Medicaid
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
Medicare Part A
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
Medicare Part B
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
POS
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
PPO
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna
Workers Comp
O
266.00
102.95
154.28
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
EPO
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
HMO
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
Medicaid
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
Medicare Part A
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
Medicare Part B
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
POS
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
PPO
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
aetna - medicare advantage
Workers Comp
O
266.00
102.95
149.47
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
EPO
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
HMO
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
Medicaid
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
Medicare Part A
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
Medicare Part B
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
POS
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
PPO
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield
Workers Comp
O
266.00
102.95
208.15
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
EPO
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
HMO
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
Medicaid
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
Medicare Part A
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
Medicare Part B
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
POS
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
PPO
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
blue cross blue shield - medicare advantage
Workers Comp
O
266.00
102.95
201.80
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
EPO
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
HMO
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
Medicaid
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
Medicare Part A
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
Medicare Part B
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
POS
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
PPO
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
humana - medicare advantage
Workers Comp
O
266.00
102.95
102.95
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
EPO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
HMO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
Medicaid
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
Medicare Part A
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
Medicare Part B
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
POS
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
PPO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
tricare
Workers Comp
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
EPO
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
HMO
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
Medicaid
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
Medicare Part A
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
Medicare Part B
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
POS
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
PPO
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
united healthcare
Workers Comp
O
266.00
102.95
190.01
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
EPO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
HMO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
Medicaid
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
Medicare Part A
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
Medicare Part B
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
POS
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
PPO
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77066
null
cpt
Mammography of both breasts
va
Workers Comp
O
266.00
102.95
106.79
208.15
128.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
EPO
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
HMO
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
Medicaid
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
Medicare Part A
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
Medicare Part B
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
POS
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
PPO
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna
Workers Comp
O
312.75
85.12
181.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
EPO
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
HMO
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
Medicaid
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
Medicare Part A
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
Medicare Part B
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
POS
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
PPO
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
aetna - medicare advantage
Workers Comp
O
312.75
85.12
87.73
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
EPO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
HMO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
Medicaid
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
Medicare Part A
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
Medicare Part B
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
POS
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
PPO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield
Workers Comp
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
EPO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
HMO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
Medicaid
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
Medicare Part A
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
Medicare Part B
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
POS
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
PPO
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
blue cross blue shield - medicare advantage
Workers Comp
O
312.75
85.12
301.25
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
EPO
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
HMO
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
Medicaid
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
Medicare Part A
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
Medicare Part B
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
POS
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
PPO
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
cigna
Workers Comp
O
312.75
85.12
208.80
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
EPO
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
HMO
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
Medicaid
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
Medicare Part A
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
Medicare Part B
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
POS
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
PPO
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana
Workers Comp
O
312.75
85.12
234.56
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
EPO
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
HMO
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
Medicaid
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
Medicare Part A
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
Medicare Part B
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
POS
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
PPO
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
humana - medicare advantage
Workers Comp
O
312.75
85.12
85.12
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
EPO
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
HMO
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
Medicaid
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
Medicare Part A
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
Medicare Part B
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
POS
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
PPO
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
medica
Workers Comp
O
312.75
85.12
115.72
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
EPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
HMO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
Medicaid
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
Medicare Part A
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
Medicare Part B
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
POS
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
PPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
tricare
Workers Comp
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
EPO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
HMO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
Medicaid
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
Medicare Part A
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
Medicare Part B
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
POS
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
PPO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare
Workers Comp
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
EPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
HMO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
Medicaid
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
Medicare Part A
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
Medicare Part B
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
POS
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
PPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
united healthcare - medicare advantage
Workers Comp
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
EPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
HMO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
Medicaid
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
Medicare Part A
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
Medicare Part B
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
POS
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
PPO
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
va
Workers Comp
O
312.75
85.12
88.57
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
EPO
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
HMO
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
Medicaid
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
Medicare Part A
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
Medicare Part B
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
POS
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
PPO
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
webtpa
Workers Comp
O
312.75
85.12
208.50
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
EPO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
HMO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
Medicaid
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
Medicare Part A
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
Medicare Part B
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
POS
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
PPO
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77067
null
cpt
Mammography screening bilateral
worker comp
Workers Comp
O
312.75
85.12
223.40
301.25
104.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
EPO
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
HMO
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
Medicaid
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
Medicare Part A
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
Medicare Part B
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
POS
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
PPO
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77072
null
cpt
Imaging for bone age assessment
tricare
Workers Comp
O
213.69
97.90
97.90
97.90
128.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
EPO
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
HMO
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
Medicaid
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
Medicare Part A
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
Medicare Part B
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
POS
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
PPO
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77073
null
cpt
Imaging for bone length assessment
blue cross blue shield
Workers Comp
O
445.47
63.94
63.94
63.94
267.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
EPO
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
HMO
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
Medicaid
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
Medicare Part A
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
Medicare Part B
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
POS
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
PPO
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
blue cross blue shield
Workers Comp
O
654.44
61.44
61.44
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
EPO
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
HMO
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
Medicaid
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
Medicare Part A
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
Medicare Part B
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
POS
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
PPO
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77075
null
cpt
X-ray survey of forearm or wrist bone density
humana - medicare advantage
Workers Comp
O
654.44
61.44
97.90
97.90
392.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
EPO
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
HMO
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
Medicaid
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
Medicare Part A
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
Medicare Part B
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
POS
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
PPO
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna
Workers Comp
O
332.78
26.92
186.99
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
EPO
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
HMO
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
Medicaid
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
Medicare Part A
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
Medicare Part B
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
POS
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
PPO
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
aetna - medicare advantage
Workers Comp
O
332.78
26.92
99.29
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
EPO
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
HMO
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
Medicaid
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
Medicare Part A
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
Medicare Part B
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
POS
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
PPO
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield
Workers Comp
O
332.78
26.92
125.95
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
EPO
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
HMO
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
Medicaid
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
Medicare Part A
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
Medicare Part B
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
POS
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
PPO
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
blue cross blue shield - medicare advantage
Workers Comp
O
332.78
26.92
98.59
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
EPO
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
HMO
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
Medicaid
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
Medicare Part A
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
Medicare Part B
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
POS
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
PPO
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
humana - medicare advantage
Workers Comp
O
332.78
26.92
97.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
EPO
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
HMO
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
Medicaid
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
Medicare Part A
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
Medicare Part B
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
POS
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
PPO
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
tricare
Workers Comp
O
332.78
26.92
97.02
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
EPO
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
HMO
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
Medicaid
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
Medicare Part A
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
Medicare Part B
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
POS
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
PPO
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare
Workers Comp
O
332.78
26.92
237.71
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
EPO
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
HMO
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
Medicaid
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
Medicare Part A
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
Medicare Part B
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
POS
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
PPO
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
united healthcare - medicare advantage
Workers Comp
O
332.78
26.92
98.30
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
EPO
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
HMO
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
Medicaid
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
Medicare Part A
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
Medicare Part B
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
POS
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
PPO
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
va
Workers Comp
O
332.78
26.92
26.92
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
EPO
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
HMO
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
Medicaid
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
Medicare Part A
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
Medicare Part B
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
POS
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
PPO
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77080
null
cpt
Bone density measurement of the core or central skeleton (e.g. hips pelvis spine)
webtpa
Workers Comp
O
332.78
26.92
221.86
237.71
116.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
EPO
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
HMO
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
Medicaid
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
Medicare Part A
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
Medicare Part B
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
POS
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
PPO
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna
Workers Comp
O
978.32
112.14
567.43
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
EPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
HMO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
Medicaid
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
Medicare Part A
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
Medicare Part B
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
POS
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
PPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
aetna - medicare advantage
Workers Comp
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
EPO
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
HMO
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
Medicaid
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
Medicare Part A
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
Medicare Part B
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
POS
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
PPO
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield
Workers Comp
O
978.32
112.14
700.06
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
EPO
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
HMO
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
Medicaid
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
Medicare Part A
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
Medicare Part B
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
POS
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
PPO
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
blue cross blue shield - medicare advantage
Workers Comp
O
978.32
112.14
443.92
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
EPO
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
HMO
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
Medicaid
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
Medicare Part A
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
Medicare Part B
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
POS
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
PPO
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
cigna
Workers Comp
O
978.32
112.14
692.28
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
EPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
HMO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
Medicaid
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
Medicare Part A
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
Medicare Part B
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
POS
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
PPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
humana - medicare advantage
Workers Comp
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
EPO
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
HMO
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
Medicaid
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
Medicare Part A
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
Medicare Part B
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
POS
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
PPO
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
tricare
Workers Comp
O
978.32
112.14
112.14
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
EPO
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
HMO
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
Medicaid
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
Medicare Part A
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
Medicare Part B
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
POS
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
PPO
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
united healthcare
Workers Comp
O
978.32
112.14
698.81
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
EPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
HMO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
Medicaid
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
Medicare Part A
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
Medicare Part B
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
POS
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
PPO
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77280
null
cpt
Management of radiation therapy simulation simple
va
Workers Comp
O
978.32
112.14
112.36
700.06
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
EPO
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
HMO
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
Medicaid
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
Medicare Part A
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
Medicare Part B
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
POS
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
PPO
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna
Workers Comp
O
1845.35
271.97
1070.30
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
EPO
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
HMO
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
Medicaid
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
Medicare Part A
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
Medicare Part B
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
POS
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
PPO
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
aetna - medicare advantage
Workers Comp
O
1845.35
271.97
298.43
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
EPO
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
HMO
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
Medicaid
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
Medicare Part A
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
Medicare Part B
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
POS
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
PPO
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield
Workers Comp
O
1845.35
271.97
1183.34
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
EPO
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
HMO
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
Medicaid
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
Medicare Part A
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
Medicare Part B
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
POS
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
PPO
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
blue cross blue shield - medicare advantage
Workers Comp
O
1845.35
271.97
944.57
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
EPO
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
HMO
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
Medicaid
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
Medicare Part A
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
Medicare Part B
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
POS
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
PPO
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
humana - medicare advantage
Workers Comp
O
1845.35
271.97
299.95
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
EPO
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
HMO
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
Medicaid
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
Medicare Part A
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
Medicare Part B
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
POS
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
PPO
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
tricare
Workers Comp
O
1845.35
271.97
296.91
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
EPO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
HMO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
Medicaid
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
Medicare Part A
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
Medicare Part B
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
POS
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
PPO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare
Workers Comp
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
EPO
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
HMO
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
Medicaid
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
Medicare Part A
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
Medicare Part B
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
POS
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
PPO
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
united healthcare - medicare advantage
Workers Comp
O
1845.35
271.97
271.97
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
EPO
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
HMO
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
Medicaid
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
Medicare Part A
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
Medicare Part B
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
POS
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
PPO
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
va
Workers Comp
O
1845.35
271.97
299.94
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
EPO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
HMO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
Medicaid
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
Medicare Part A
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
Medicare Part B
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
POS
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
PPO
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77290
null
cpt
Management of radiation therapy simulation complex
worker comp
Workers Comp
O
1845.35
271.97
1318.11
1318.11
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
EPO
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
HMO
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
Medicaid
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
Medicare Part A
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
Medicare Part B
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
POS
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
PPO
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna
Workers Comp
O
1817.52
939.67
1086.00
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
EPO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
HMO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
Medicaid
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
Medicare Part A
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
Medicare Part B
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
POS
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
PPO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
aetna - medicare advantage
Workers Comp
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
EPO
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
HMO
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
Medicaid
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
Medicare Part A
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
Medicare Part B
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
POS
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
PPO
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield
Workers Comp
O
1817.52
939.67
1003.61
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
EPO
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
HMO
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
Medicaid
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
Medicare Part A
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
Medicare Part B
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
POS
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
PPO
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
blue cross blue shield - medicare advantage
Workers Comp
O
1817.52
939.67
939.67
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
EPO
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
HMO
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
Medicaid
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
Medicare Part A
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
Medicare Part B
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
POS
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
PPO
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
cigna
Workers Comp
O
1817.52
939.67
1286.12
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
EPO
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
HMO
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
Medicaid
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
Medicare Part A
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
Medicare Part B
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
POS
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
PPO
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
humana - medicare advantage
Workers Comp
O
1817.52
939.67
1117.84
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
EPO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
HMO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
Medicaid
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
Medicare Part A
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
Medicare Part B
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
POS
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
PPO
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
tricare
Workers Comp
O
1817.52
939.67
1103.22
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
EPO
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
HMO
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
Medicaid
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
Medicare Part A
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
Medicare Part B
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
POS
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
PPO
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare
Workers Comp
O
1817.52
939.67
1298.24
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
EPO
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
HMO
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
Medicaid
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
Medicare Part A
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
Medicare Part B
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
POS
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
PPO
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
united healthcare - medicare advantage
Workers Comp
O
1817.52
939.67
1007.31
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
EPO
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
HMO
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
Medicaid
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
Medicare Part A
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
Medicare Part B
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
POS
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
PPO
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77295
null
cpt
Management of radiation therapy 3D
va
Workers Comp
O
1817.52
939.67
1117.80
1298.24
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
EPO
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
HMO
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
Medicaid
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
Medicare Part A
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
Medicare Part B
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
POS
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
PPO
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna
Workers Comp
O
273.70
104.60
430.59
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
EPO
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
HMO
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
Medicaid
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
Medicare Part A
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
Medicare Part B
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
POS
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
PPO
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
aetna - medicare advantage
Workers Comp
O
273.70
104.60
313.79
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
EPO
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
HMO
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
Medicaid
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
Medicare Part A
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
Medicare Part B
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
POS
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
PPO
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield
Workers Comp
O
273.70
104.60
141.89
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
EPO
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
HMO
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
Medicaid
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
Medicare Part A
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
Medicare Part B
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
POS
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
PPO
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
blue cross blue shield - medicare advantage
Workers Comp
O
273.70
104.60
122.67
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
EPO
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
HMO
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
Medicaid
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
Medicare Part A
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
Medicare Part B
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
POS
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
PPO
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
cigna
Workers Comp
O
273.70
104.60
182.72
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
EPO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
HMO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
Medicaid
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
Medicare Part A
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
Medicare Part B
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
POS
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
PPO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
humana - medicare advantage
Workers Comp
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
EPO
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
HMO
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
Medicaid
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
Medicare Part A
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
Medicare Part B
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
POS
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
PPO
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
tricare
Workers Comp
O
273.70
104.60
112.26
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
EPO
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
HMO
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
Medicaid
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
Medicare Part A
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
Medicare Part B
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
POS
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
PPO
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare
Workers Comp
O
273.70
104.60
184.44
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
EPO
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
HMO
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
Medicaid
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
Medicare Part A
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
Medicare Part B
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
POS
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
PPO
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
united healthcare - medicare advantage
Workers Comp
O
273.70
104.60
104.60
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
EPO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
HMO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
Medicaid
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
Medicare Part A
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
Medicare Part B
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
POS
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
PPO
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77300
null
cpt
Calculation of radiation therapy dose
va
Workers Comp
O
273.70
104.60
112.36
430.59
252.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
EPO
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
HMO
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
Medicaid
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
Medicare Part A
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
Medicare Part B
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
POS
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
PPO
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna
Workers Comp
O
7296.82
1089.98
4232.16
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
EPO
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
HMO
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
Medicaid
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
Medicare Part A
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
Medicare Part B
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
POS
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
PPO
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
aetna - medicare advantage
Workers Comp
O
7296.82
1089.98
1089.98
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
EPO
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
HMO
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
Medicaid
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
Medicare Part A
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
Medicare Part B
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
POS
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
PPO
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield
Workers Comp
O
7296.82
1089.98
1716.53
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
EPO
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
HMO
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
Medicaid
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
Medicare Part A
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
Medicare Part B
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
POS
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
PPO
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
blue cross blue shield - medicare advantage
Workers Comp
O
7296.82
1089.98
1134.50
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
EPO
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
HMO
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
Medicaid
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
Medicare Part A
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
Medicare Part B
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
POS
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
PPO
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
humana - medicare advantage
Workers Comp
O
7296.82
1089.98
1117.84
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
EPO
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
HMO
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
Medicaid
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
Medicare Part A
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
Medicare Part B
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
POS
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
PPO
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
tricare
Workers Comp
O
7296.82
1089.98
1103.22
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
EPO
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
HMO
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
Medicaid
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
Medicare Part A
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
Medicare Part B
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
POS
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
PPO
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
united healthcare
Workers Comp
O
7296.82
1089.98
5212.02
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
EPO
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
HMO
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
Medicaid
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
Medicare Part A
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
Medicare Part B
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
POS
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
PPO
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77301
null
cpt
Management of modulation radiotherapy planning
va
Workers Comp
O
7296.82
1089.98
1117.80
5212.02
1323.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
EPO
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
HMO
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
Medicaid
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
Medicare Part A
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
Medicare Part B
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
POS
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
PPO
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77317
null
cpt
Radiation therapy plan intermediate for insertion of radioactive implant
united healthcare
Workers Comp
O
853.30
639.98
639.98
639.98
511.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
EPO
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
HMO
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
Medicaid
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
Medicare Part A
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
Medicare Part B
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
POS
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
PPO
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna
Workers Comp
O
352.82
246.97
250.78
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
EPO
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
HMO
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
Medicaid
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
Medicare Part A
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
Medicare Part B
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
POS
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
PPO
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
aetna - medicare advantage
Workers Comp
O
352.82
246.97
286.10
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
EPO
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
HMO
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
Medicaid
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
Medicare Part A
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
Medicare Part B
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
POS
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
PPO
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
blue cross blue shield
Workers Comp
O
352.82
246.97
264.62
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
EPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
HMO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
Medicaid
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
Medicare Part A
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
Medicare Part B
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
POS
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
PPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
humana - medicare advantage
Workers Comp
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
EPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
HMO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
Medicaid
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
Medicare Part A
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
Medicare Part B
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
POS
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
PPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
tricare
Workers Comp
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
EPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
HMO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
Medicaid
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
Medicare Part A
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
Medicare Part B
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
POS
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
PPO
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
united healthcare - medicare advantage
Workers Comp
O
352.82
246.97
296.91
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
EPO
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
HMO
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
Medicaid
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
Medicare Part A
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
Medicare Part B
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
POS
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
PPO
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
webtpa
Workers Comp
O
352.82
246.97
246.97
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
EPO
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
HMO
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
Medicaid
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
Medicare Part A
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
Medicare Part B
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
POS
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
PPO
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77321
null
cpt
Radiation therapy total body port plan
worker comp
Workers Comp
O
352.82
246.97
252.02
296.91
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
EPO
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
HMO
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
Medicaid
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
Medicare Part A
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
Medicare Part B
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
POS
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
PPO
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
blue cross blue shield
Workers Comp
O
289.38
217.04
241.55
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
EPO
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
HMO
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
Medicaid
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
Medicare Part A
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
Medicare Part B
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
POS
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
PPO
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77332
null
cpt
Radiation treatment devices design and construction simple
united healthcare
Workers Comp
O
289.38
217.04
217.04
241.55
173.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
EPO
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
HMO
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
Medicaid
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
Medicare Part A
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
Medicare Part B
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
POS
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
PPO
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna
Workers Comp
O
565.40
271.97
327.93
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
EPO
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
HMO
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
Medicaid
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
Medicare Part A
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
Medicare Part B
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
POS
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
PPO
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
aetna - medicare advantage
Workers Comp
O
565.40
271.97
298.43
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
EPO
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
HMO
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
Medicaid
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
Medicare Part A
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
Medicare Part B
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
POS
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
PPO
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield
Workers Comp
O
565.40
271.97
327.68
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
EPO
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
HMO
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
Medicaid
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
Medicare Part A
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
Medicare Part B
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
POS
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
PPO
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
blue cross blue shield - medicare advantage
Workers Comp
O
565.40
271.97
311.32
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
EPO
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
HMO
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
Medicaid
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
Medicare Part A
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
Medicare Part B
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
POS
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
PPO
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
cigna
Workers Comp
O
565.40
271.97
400.09
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
EPO
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
HMO
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
Medicaid
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
Medicare Part A
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
Medicare Part B
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
POS
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
PPO
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
humana - medicare advantage
Workers Comp
O
565.40
271.97
299.95
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
EPO
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
HMO
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
Medicaid
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
Medicare Part A
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
Medicare Part B
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
POS
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
PPO
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
tricare
Workers Comp
O
565.40
271.97
296.91
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
EPO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
HMO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
Medicaid
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
Medicare Part A
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
Medicare Part B
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
POS
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
PPO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare
Workers Comp
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
EPO
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
HMO
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
Medicaid
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
Medicare Part A
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
Medicare Part B
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
POS
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
PPO
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
united healthcare - medicare advantage
Workers Comp
O
565.40
271.97
271.97
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
EPO
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
HMO
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
Medicaid
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
Medicare Part A
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
Medicare Part B
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
POS
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
PPO
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
va
Workers Comp
O
565.40
271.97
299.94
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
EPO
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
HMO
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
Medicaid
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
Medicare Part A
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
Medicare Part B
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
POS
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
PPO
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
webtpa
Workers Comp
O
565.40
271.97
395.78
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
EPO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
HMO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
Medicaid
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
Medicare Part A
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
Medicare Part B
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
POS
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
PPO
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77334
null
cpt
Radiation treatment devices design and construction complex
worker comp
Workers Comp
O
565.40
271.97
403.86
403.86
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
EPO
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
HMO
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
Medicaid
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
Medicare Part A
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
Medicare Part B
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
POS
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
PPO
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna
Workers Comp
O
272.68
109.90
158.15
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
EPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
HMO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
Medicaid
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
Medicare Part A
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
Medicare Part B
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
POS
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
PPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
aetna - medicare advantage
Workers Comp
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
EPO
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
HMO
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
Medicaid
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
Medicare Part A
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
Medicare Part B
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
POS
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
PPO
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield
Workers Comp
O
272.68
109.90
135.81
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
EPO
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
HMO
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
Medicaid
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
Medicare Part A
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
Medicare Part B
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
POS
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
PPO
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
blue cross blue shield - medicare advantage
Workers Comp
O
272.68
109.90
187.29
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
EPO
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
HMO
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
Medicaid
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
Medicare Part A
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
Medicare Part B
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
POS
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
PPO
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
cigna
Workers Comp
O
272.68
109.90
192.96
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
EPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
HMO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
Medicaid
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
Medicare Part A
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
Medicare Part B
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
POS
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
PPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
humana - medicare advantage
Workers Comp
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
EPO
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
HMO
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
Medicaid
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
Medicare Part A
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
Medicare Part B
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
POS
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
PPO
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
tricare
Workers Comp
O
272.68
109.90
112.14
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
EPO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
HMO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
Medicaid
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
Medicare Part A
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
Medicare Part B
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
POS
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
PPO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare
Workers Comp
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
EPO
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
HMO
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
Medicaid
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
Medicare Part A
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
Medicare Part B
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
POS
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
PPO
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
united healthcare - medicare advantage
Workers Comp
O
272.68
109.90
109.90
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
EPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
HMO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
Medicaid
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
Medicare Part A
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
Medicare Part B
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
POS
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
PPO
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
va
Workers Comp
O
272.68
109.90
112.36
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
EPO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
HMO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
Medicaid
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
Medicare Part A
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
Medicare Part B
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
POS
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
PPO
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77336
null
cpt
Radiation therapy consultation per week
worker comp
Workers Comp
O
272.68
109.90
194.78
194.78
134.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
EPO
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
HMO
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
Medicaid
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
Medicare Part A
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
Medicare Part B
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
POS
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
PPO
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna
Workers Comp
O
1913.24
293.35
1109.68
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
EPO
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
HMO
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
Medicaid
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
Medicare Part A
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
Medicare Part B
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
POS
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
PPO
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
aetna - medicare advantage
Workers Comp
O
1913.24
293.35
293.35
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
EPO
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
HMO
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
Medicaid
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
Medicare Part A
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
Medicare Part B
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
POS
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
PPO
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield
Workers Comp
O
1913.24
293.35
450.08
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
EPO
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
HMO
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
Medicaid
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
Medicare Part A
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
Medicare Part B
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
POS
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
PPO
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
blue cross blue shield - medicare advantage
Workers Comp
O
1913.24
293.35
297.47
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
EPO
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
HMO
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
Medicaid
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
Medicare Part A
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
Medicare Part B
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
POS
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
PPO
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
humana - medicare advantage
Workers Comp
O
1913.24
293.35
299.95
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
EPO
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
HMO
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
Medicaid
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
Medicare Part A
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
Medicare Part B
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
POS
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
PPO
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
tricare
Workers Comp
O
1913.24
293.35
296.91
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
EPO
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
HMO
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
Medicaid
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
Medicare Part A
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
Medicare Part B
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
POS
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
PPO
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
united healthcare
Workers Comp
O
1913.24
293.35
1366.61
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
EPO
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
HMO
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
Medicaid
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
Medicare Part A
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
Medicare Part B
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
POS
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
PPO
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77338
null
cpt
Design and construction of device for radiation therapy
va
Workers Comp
O
1913.24
293.35
299.94
1366.61
356.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
EPO
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
HMO
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
Medicaid
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
Medicare Part A
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
Medicare Part B
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
POS
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
PPO
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77370
null
cpt
Radiation therapy consultation
united healthcare
Workers Comp
O
398.56
298.92
298.92
298.92
239.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
EPO
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
HMO
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
Medicaid
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
Medicare Part A
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
Medicare Part B
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
POS
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
PPO
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77372
null
cpt
Radiation therapy delivery stereotactic radiosurgery (SRS) for cranial growths per session using a linear accelerator
blue cross blue shield
Workers Comp
O
21891.12
2685.38
2685.38
2685.38
13134.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
EPO
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
HMO
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
Medicaid
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
Medicare Part A
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
Medicare Part B
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
POS
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
PPO
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield
Workers Comp
O
4121.25
848.46
848.46
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
EPO
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
HMO
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
Medicaid
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part A
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
Medicare Part B
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
POS
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
PPO
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
blue cross blue shield - medicare advantage
Workers Comp
O
4121.25
848.46
4368.52
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
EPO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
HMO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
Medicaid
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
Medicare Part A
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
Medicare Part B
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
POS
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
PPO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
humana - medicare advantage
Workers Comp
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
EPO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
HMO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
Medicaid
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
Medicare Part A
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
Medicare Part B
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
POS
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
PPO
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
tricare
Workers Comp
O
4121.25
848.46
1535.47
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
EPO
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
HMO
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
Medicaid
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
Medicare Part A
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
Medicare Part B
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
POS
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
PPO
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
va
Workers Comp
O
4121.25
848.46
1535.42
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
EPO
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
HMO
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
Medicaid
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
Medicare Part A
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
Medicare Part B
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
POS
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
PPO
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77373
null
cpt
Stereotactic body radiation therapy 1 or more lesions using imaging guidance
webtpa
Workers Comp
O
4121.25
848.46
2884.88
4368.52
1842.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
EPO
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
HMO
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
Medicaid
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
Medicare Part A
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
Medicare Part B
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
POS
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
PPO
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield
Workers Comp
O
1685.08
480.49
717.89
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
EPO
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
HMO
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
Medicaid
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
Medicare Part A
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
Medicare Part B
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
POS
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
PPO
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
blue cross blue shield - medicare advantage
Workers Comp
O
1685.08
480.49
622.03
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
EPO
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
HMO
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
Medicaid
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
Medicare Part A
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
Medicare Part B
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
POS
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
PPO
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
humana - medicare advantage
Workers Comp
O
1685.08
480.49
480.50
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
EPO
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
HMO
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
Medicaid
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
Medicare Part A
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
Medicare Part B
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
POS
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
PPO
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77385
null
cpt
Intensity modulated radiation therapy delivery simple
va
Workers Comp
O
1685.08
480.49
480.49
717.89
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
EPO
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
HMO
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
Medicaid
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
Medicare Part A
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
Medicare Part B
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
POS
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
PPO
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna
Workers Comp
O
2248.26
458.62
1303.99
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
EPO
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
HMO
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
Medicaid
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
Medicare Part A
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
Medicare Part B
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
POS
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
PPO
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
aetna - medicare advantage
Workers Comp
O
2248.26
458.62
472.57
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
EPO
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
HMO
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
Medicaid
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
Medicare Part A
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
Medicare Part B
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
POS
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
PPO
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield
Workers Comp
O
2248.26
458.62
776.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
EPO
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
HMO
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
Medicaid
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
Medicare Part A
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
Medicare Part B
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
POS
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
PPO
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
blue cross blue shield - medicare advantage
Workers Comp
O
2248.26
458.62
458.62
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
EPO
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
HMO
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
Medicaid
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
Medicare Part A
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
Medicare Part B
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
POS
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
PPO
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
cigna
Workers Comp
O
2248.26
458.62
1590.91
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
EPO
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
HMO
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
Medicaid
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
Medicare Part A
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
Medicare Part B
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
POS
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
PPO
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
humana - medicare advantage
Workers Comp
O
2248.26
458.62
480.50
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
EPO
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
HMO
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
Medicaid
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
Medicare Part A
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
Medicare Part B
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
POS
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
PPO
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
tricare
Workers Comp
O
2248.26
458.62
477.34
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
EPO
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
HMO
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
Medicaid
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
Medicare Part A
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
Medicare Part B
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
POS
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
PPO
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
united healthcare
Workers Comp
O
2248.26
458.62
1605.90
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
EPO
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
HMO
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
Medicaid
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
Medicare Part A
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
Medicare Part B
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
POS
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
PPO
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77386
null
cpt
Intensity modulated radiation therapy delivery complex
va
Workers Comp
O
2248.26
458.62
480.49
1605.90
572.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
EPO
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
HMO
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
Medicaid
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
Medicare Part A
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
Medicare Part B
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
POS
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
PPO
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
blue cross blue shield
Workers Comp
O
272.71
158.82
158.82
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
EPO
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
HMO
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
Medicaid
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
Medicare Part A
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
Medicare Part B
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
POS
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
PPO
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare
Workers Comp
O
272.71
158.82
199.55
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
EPO
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
HMO
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
Medicaid
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
Medicare Part A
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
Medicare Part B
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
POS
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
PPO
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77387
null
cpt
Guidance for localization of target delivery of radiation treatment
united healthcare - medicare advantage
Workers Comp
O
272.71
158.82
266.06
266.06
75.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
EPO
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
HMO
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
Medicaid
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
Medicare Part A
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
Medicare Part B
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
POS
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
PPO
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna
Workers Comp
O
880.38
205.21
510.62
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
EPO
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
HMO
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
Medicaid
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
Medicare Part A
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
Medicare Part B
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
POS
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
PPO
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
aetna - medicare advantage
Workers Comp
O
880.38
205.21
214.04
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
EPO
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
HMO
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
Medicaid
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
Medicare Part A
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
Medicare Part B
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
POS
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
PPO
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield
Workers Comp
O
880.38
205.21
660.29
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
EPO
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
HMO
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
Medicaid
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
Medicare Part A
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
Medicare Part B
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
POS
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
PPO
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
blue cross blue shield - medicare advantage
Workers Comp
O
880.38
205.21
611.33
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
EPO
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
HMO
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
Medicaid
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
Medicare Part A
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
Medicare Part B
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
POS
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
PPO
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
cigna
Workers Comp
O
880.38
205.21
622.98
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
EPO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
HMO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
Medicaid
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
Medicare Part A
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
Medicare Part B
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
POS
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
PPO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
humana - medicare advantage
Workers Comp
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
EPO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
HMO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
Medicaid
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
Medicare Part A
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
Medicare Part B
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
POS
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
PPO
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
tricare
Workers Comp
O
880.38
205.21
209.39
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
EPO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
HMO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
Medicaid
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
Medicare Part A
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
Medicare Part B
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
POS
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
PPO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare
Workers Comp
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
EPO
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
HMO
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
Medicaid
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
Medicare Part A
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
Medicare Part B
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
POS
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
PPO
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
united healthcare - medicare advantage
Workers Comp
O
880.38
205.21
205.21
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
EPO
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
HMO
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
Medicaid
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
Medicare Part A
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
Medicare Part B
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
POS
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
PPO
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
va
Workers Comp
O
880.38
205.21
214.03
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
EPO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
HMO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
Medicaid
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
Medicare Part A
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
Medicare Part B
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
POS
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
PPO
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77412
null
cpt
Radiation treatment delivery complex
worker comp
Workers Comp
O
880.38
205.21
628.85
660.29
251.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
EPO
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
HMO
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
Medicaid
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
Medicare Part A
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
Medicare Part B
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
POS
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
PPO
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
aetna
Workers Comp
O
37.84
21.95
21.95
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
EPO
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
HMO
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
Medicaid
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
Medicare Part A
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
Medicare Part B
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
POS
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
PPO
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield
Workers Comp
O
37.84
21.95
28.65
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
EPO
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
HMO
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
Medicaid
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
Medicare Part A
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
Medicare Part B
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
POS
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
PPO
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
blue cross blue shield - medicare advantage
Workers Comp
O
37.84
21.95
26.28
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
EPO
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
HMO
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
Medicaid
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
Medicare Part A
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
Medicare Part B
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
POS
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
PPO
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
cigna
Workers Comp
O
37.84
21.95
26.78
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
EPO
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
HMO
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
Medicaid
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
Medicare Part A
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
Medicare Part B
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
POS
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
PPO
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77417
null
cpt
Therapeutic radiology port films
united healthcare
Workers Comp
O
37.84
21.95
27.03
28.65
10.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
EPO
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
HMO
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
Medicaid
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
Medicare Part A
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
Medicare Part B
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
POS
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
PPO
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77470
null
cpt
Special radiation treatment procedure
united healthcare
Workers Comp
O
564.98
423.74
423.74
423.74
338.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
EPO
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
HMO
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
Medicaid
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
Medicare Part A
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
Medicare Part B
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
POS
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
PPO
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield
Workers Comp
I
15224.10
2639.44
6189.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
EPO
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
HMO
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
Medicaid
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
Medicare Part A
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
Medicare Part B
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
POS
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
PPO
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
blue cross blue shield - medicare advantage
Workers Comp
I
15224.10
2639.44
9082.13
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
EPO
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
HMO
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
Medicaid
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
Medicare Part A
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
Medicare Part B
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
POS
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
PPO
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
tricare
Workers Comp
I
15224.10
2639.44
2639.44
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
EPO
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
HMO
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
Medicaid
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
Medicare Part A
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
Medicare Part B
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
POS
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
PPO
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
776
null
ms-drg
postpartum and post abortion diagnoses without o.r. procedures
united healthcare
Workers Comp
I
15224.10
2639.44
11003.96
11003.96
9134.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
EPO
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
HMO
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
Medicaid
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
Medicare Part A
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
Medicare Part B
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
POS
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
PPO
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
77771
null
cpt
High dose brachytherapy  2- 12 channels
united healthcare
Workers Comp
O
2058.52
1543.89
1543.89
1543.89
787.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
EPO
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
HMO
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
Medicaid
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
Medicare Part A
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
Medicare Part B
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
POS
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
PPO
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
779
null
ms-drg
abortion without d&c
blue cross blue shield
Workers Comp
I
9075.78
3624.50
3624.50
3624.50
5445.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
EPO
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
HMO
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
Medicaid
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
Medicare Part A
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
Medicare Part B
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
POS
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
PPO
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
aetna
Workers Comp
O
1160.85
333.99
652.29
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
EPO
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
HMO
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
Medicaid
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
Medicare Part A
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
Medicare Part B
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
POS
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
PPO
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
blue cross blue shield
Workers Comp
O
1160.85
333.99
757.43
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
EPO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
HMO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
Medicaid
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
Medicare Part A
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
Medicare Part B
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
POS
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
PPO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
humana - medicare advantage
Workers Comp
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
EPO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
HMO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
Medicaid
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
Medicare Part A
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
Medicare Part B
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
POS
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
PPO
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78014
null
cpt
Thyroid imaging with vascular flow
tricare
Workers Comp
O
1160.85
333.99
333.99
757.43
696.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78018
null
cpt
Nuclear medicine whole body study for thyroid cancer
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
78070
null
cpt
Imaging of parathyroid
aetna
EPO
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
HMO
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
Medicaid
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
Medicare Part A
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
Medicare Part B
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
POS
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
PPO
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
aetna
Workers Comp
O
1239.88
400.83
749.13
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
EPO
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
HMO
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
Medicaid
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
Medicare Part A
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
Medicare Part B
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
POS
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
PPO
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
blue cross blue shield - medicare advantage
Workers Comp
O
1239.88
400.83
400.83
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
EPO
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
HMO
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
Medicaid
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
Medicare Part A
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
Medicare Part B
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
POS
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
PPO
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78070
null
cpt
Imaging of parathyroid
united healthcare
Workers Comp
O
1239.88
400.83
885.63
885.63
743.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
EPO
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
HMO
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
Medicaid
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
Medicare Part A
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
Medicare Part B
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
POS
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
PPO
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield
Workers Comp
O
2534.30
7.87
955.30
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
EPO
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
HMO
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
Medicaid
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
Medicare Part A
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
Medicare Part B
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
POS
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
PPO
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78195
null
cpt
Imaging of lymphatic tissue and lymph node
blue cross blue shield - medicare advantage
Workers Comp
O
2534.30
7.87
7.87
955.30
1520.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
EPO
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
HMO
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
Medicaid
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
Medicare Part A
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
Medicare Part B
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
POS
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
PPO
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna
Workers Comp
O
1442.44
161.81
836.62
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
EPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
HMO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
Medicaid
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
Medicare Part A
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
Medicare Part B
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
POS
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
PPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
aetna - medicare advantage
Workers Comp
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
EPO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
HMO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
Medicaid
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
Medicare Part A
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
Medicare Part B
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
POS
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
PPO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield
Workers Comp
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
EPO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
HMO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
Medicaid
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
Medicare Part A
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
Medicare Part B
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
POS
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
PPO
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
blue cross blue shield - medicare advantage
Workers Comp
O
1442.44
161.81
1038.75
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
EPO
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
HMO
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
Medicaid
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
Medicare Part A
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
Medicare Part B
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
POS
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
PPO
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
humana - medicare advantage
Workers Comp
O
1442.44
161.81
433.43
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
EPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
HMO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
Medicaid
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
Medicare Part A
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
Medicare Part B
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
POS
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
PPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
tricare
Workers Comp
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
EPO
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
HMO
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
Medicaid
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
Medicare Part A
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
Medicare Part B
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
POS
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
PPO
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare
Workers Comp
O
1442.44
161.81
1030.32
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
EPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
HMO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
Medicaid
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
Medicare Part A
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
Medicare Part B
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
POS
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
PPO
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
united healthcare - medicare advantage
Workers Comp
O
1442.44
161.81
418.12
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
EPO
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
HMO
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
Medicaid
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
Medicare Part A
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
Medicare Part B
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
POS
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
PPO
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
va
Workers Comp
O
1442.44
161.81
372.60
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
EPO
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
HMO
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
Medicaid
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
Medicare Part A
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
Medicare Part B
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
POS
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
PPO
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78227
null
cpt
Imaging of liver and bile duct system with use of drugs
webtpa
Workers Comp
O
1442.44
161.81
161.81
1038.75
501.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
EPO
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
HMO
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
Medicaid
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
Medicare Part A
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
Medicare Part B
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
POS
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
PPO
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield
Workers Comp
O
1451.35
326.12
1039.59
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
EPO
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
HMO
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
Medicaid
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
Medicare Part A
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
Medicare Part B
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
POS
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
PPO
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
blue cross blue shield - medicare advantage
Workers Comp
O
1451.35
326.12
924.28
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
EPO
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
HMO
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
Medicaid
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
Medicare Part A
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
Medicare Part B
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
POS
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
PPO
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
cigna
Workers Comp
O
1451.35
326.12
1027.00
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
EPO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
HMO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
Medicaid
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
Medicare Part A
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
Medicare Part B
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
POS
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
PPO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
humana - medicare advantage
Workers Comp
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
EPO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
HMO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
Medicaid
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
Medicare Part A
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
Medicare Part B
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
POS
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
PPO
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
tricare
Workers Comp
O
1451.35
326.12
326.12
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
EPO
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
HMO
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
Medicaid
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
Medicare Part A
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
Medicare Part B
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
POS
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
PPO
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78264
null
cpt
Stomach emptying study
va
Workers Comp
O
1451.35
326.12
333.98
1039.59
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
EPO
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
HMO
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
Medicaid
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
Medicare Part A
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
Medicare Part B
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
POS
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
PPO
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78290
null
cpt
Intestine imaging
tricare
Workers Comp
O
1387.54
304.84
304.84
304.84
832.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
EPO
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
HMO
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
Medicaid
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
Medicare Part A
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
Medicare Part B
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
POS
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
PPO
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna
Workers Comp
O
800.20
326.12
449.64
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
EPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
HMO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
Medicaid
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
Medicare Part A
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
Medicare Part B
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
POS
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
PPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
aetna - medicare advantage
Workers Comp
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
EPO
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
HMO
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
Medicaid
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
Medicare Part A
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
Medicare Part B
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
POS
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
PPO
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield
Workers Comp
O
800.20
326.12
522.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
EPO
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
HMO
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
Medicaid
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
Medicare Part A
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
Medicare Part B
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
POS
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
PPO
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
blue cross blue shield - medicare advantage
Workers Comp
O
800.20
326.12
397.84
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
EPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
HMO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
Medicaid
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
Medicare Part A
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
Medicare Part B
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
POS
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
PPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
humana - medicare advantage
Workers Comp
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
EPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
HMO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
Medicaid
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
Medicare Part A
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
Medicare Part B
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
POS
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
PPO
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
tricare
Workers Comp
O
800.20
326.12
326.12
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
EPO
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
HMO
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
Medicaid
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
Medicare Part A
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
Medicare Part B
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
POS
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
PPO
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78306
null
cpt
Bone and/or joint imaging whole body
va
Workers Comp
O
800.20
326.12
333.98
522.98
391.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
EPO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
HMO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
Medicaid
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
Medicare Part A
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
Medicare Part B
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
POS
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
PPO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield
Workers Comp
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
EPO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
HMO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
Medicaid
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
Medicare Part A
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
Medicare Part B
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
POS
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
PPO
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
blue cross blue shield - medicare advantage
Workers Comp
O
1915.47
326.12
676.94
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
EPO
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
HMO
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
Medicaid
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
Medicare Part A
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
Medicare Part B
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
POS
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
PPO
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
humana - medicare advantage
Workers Comp
O
1915.47
326.12
333.99
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
EPO
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
HMO
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
Medicaid
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
Medicare Part A
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
Medicare Part B
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
POS
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
PPO
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
tricare
Workers Comp
O
1915.47
326.12
326.12
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
EPO
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
HMO
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
Medicaid
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
Medicare Part A
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
Medicare Part B
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
POS
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
PPO
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
united healthcare
Workers Comp
O
1915.47
326.12
1368.20
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
EPO
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
HMO
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
Medicaid
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
Medicare Part A
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
Medicare Part B
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
POS
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
PPO
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78315
null
cpt
Bone and/or joint imaging 3 phase study
va
Workers Comp
O
1915.47
326.12
333.98
1368.20
1149.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
EPO
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
HMO
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
Medicaid
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
Medicare Part A
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
Medicare Part B
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
POS
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
PPO
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield
Workers Comp
I
14820.34
5248.85
12398.63
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
EPO
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
HMO
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
Medicaid
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
POS
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
PPO
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
blue cross blue shield - medicare advantage
Workers Comp
I
14820.34
5248.85
9277.48
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
EPO
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
HMO
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
Medicaid
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
Medicare Part A
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
Medicare Part B
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
POS
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
PPO
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
humana - medicare advantage
Workers Comp
I
14820.34
5248.85
6000.05
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
EPO
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
HMO
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
Medicaid
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
Medicare Part A
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
Medicare Part B
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
POS
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
PPO
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
tricare
Workers Comp
I
14820.34
5248.85
5248.85
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
EPO
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
HMO
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
Medicaid
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
Medicare Part A
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
Medicare Part B
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
POS
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
PPO
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
784
null
ms-drg
cesarean section with sterilization with cc
united healthcare
Workers Comp
I
14820.34
5248.85
24697.56
24697.56
8892.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
EPO
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
HMO
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
Medicaid
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
Medicare Part A
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
Medicare Part B
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
POS
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
PPO
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna
Workers Comp
O
5253.36
918.63
2951.89
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
EPO
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
HMO
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
Medicaid
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
Medicare Part A
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
Medicare Part B
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
POS
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
PPO
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
aetna - medicare advantage
Workers Comp
O
5253.36
918.63
1141.80
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
EPO
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
HMO
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
Medicaid
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
Medicare Part A
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
Medicare Part B
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
POS
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
PPO
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield
Workers Comp
O
5253.36
918.63
992.07
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
EPO
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
HMO
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
Medicaid
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
Medicare Part A
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
Medicare Part B
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
POS
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
PPO
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
blue cross blue shield - medicare advantage
Workers Comp
O
5253.36
918.63
918.63
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
EPO
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
HMO
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
Medicaid
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
Medicare Part A
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
Medicare Part B
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
POS
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
PPO
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
cigna
Workers Comp
O
5253.36
918.63
3612.31
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
EPO
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
HMO
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
Medicaid
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
Medicare Part A
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
Medicare Part B
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
POS
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
PPO
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
humana - medicare advantage
Workers Comp
O
5253.36
918.63
1156.59
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
EPO
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
HMO
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
Medicaid
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
Medicare Part A
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
Medicare Part B
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
POS
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
PPO
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
tricare
Workers Comp
O
5253.36
918.63
1127.01
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
EPO
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
HMO
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
Medicaid
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
Medicare Part A
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
Medicare Part B
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
POS
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
PPO
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare
Workers Comp
O
5253.36
918.63
3752.40
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
EPO
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
HMO
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
Medicaid
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
Medicare Part A
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
Medicare Part B
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
POS
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
PPO
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
united healthcare - medicare advantage
Workers Comp
O
5253.36
918.63
1108.98
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
EPO
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
HMO
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
Medicaid
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
Medicare Part A
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
Medicare Part B
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
POS
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
PPO
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78452
null
cpt
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
va
Workers Comp
O
5253.36
918.63
1156.55
3752.40
1352.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
EPO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
HMO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
Medicaid
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
Medicare Part A
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
Medicare Part B
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
POS
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
PPO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield
Workers Comp
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
EPO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
HMO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
Medicaid
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
Medicare Part A
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
Medicare Part B
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
POS
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
PPO
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
blue cross blue shield - medicare advantage
Workers Comp
O
2116.50
326.12
645.80
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
EPO
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
HMO
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
Medicaid
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
Medicare Part A
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
Medicare Part B
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
POS
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
PPO
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
humana - medicare advantage
Workers Comp
O
2116.50
326.12
326.12
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
EPO
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
HMO
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
Medicaid
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
Medicare Part A
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
Medicare Part B
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
POS
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
PPO
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78472
null
cpt
Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart single study gated equilibrium
tricare
Workers Comp
O
2116.50
326.12
333.99
645.80
1269.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
EPO
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
HMO
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
Medicaid
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
Medicare Part A
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
Medicare Part B
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
POS
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
PPO
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield
Workers Comp
I
13410.37
4526.58
9511.88
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
POS
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
13410.37
4526.58
7117.42
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
EPO
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
HMO
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
Medicaid
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
Medicare Part A
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
Medicare Part B
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
POS
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
PPO
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
785
null
ms-drg
cesarean section with sterilization without cc/mcc
tricare
Workers Comp
I
13410.37
4526.58
4526.58
9511.88
8046.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
EPO
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
HMO
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
Medicaid
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
Medicare Part A
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
Medicare Part B
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
POS
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
PPO
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield
Workers Comp
I
26485.20
11791.39
11791.39
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
EPO
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
HMO
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
Medicaid
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
POS
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
PPO
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
26485.20
11791.39
12769.57
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
EPO
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
HMO
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
Medicaid
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
Medicare Part A
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
Medicare Part B
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
POS
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
PPO
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
786
null
ms-drg
cesarean section without sterilization with mcc
united healthcare
Workers Comp
I
26485.20
11791.39
17092.44
17092.44
15891.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
EPO
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
HMO
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
Medicaid
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
Medicare Part A
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
Medicare Part B
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
POS
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
PPO
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield
Workers Comp
I
16154.33
8263.59
8998.11
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
EPO
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
HMO
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
Medicaid
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
POS
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
PPO
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
blue cross blue shield - medicare advantage
Workers Comp
I
16154.33
8263.59
8263.59
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
EPO
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
HMO
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
Medicaid
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
Medicare Part A
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
Medicare Part B
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
POS
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
PPO
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
787
null
ms-drg
cesarean section without sterilization with cc
webtpa
Workers Comp
I
16154.33
8263.59
8661.84
8998.11
9692.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
EPO
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
HMO
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
Medicaid
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
Medicare Part A
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
Medicare Part B
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
POS
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
PPO
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
blue cross blue shield
Workers Comp
O
1196.74
418.12
537.02
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
EPO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
HMO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
Medicaid
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
Medicare Part A
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
Medicare Part B
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
POS
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
PPO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
humana - medicare advantage
Workers Comp
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
EPO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
HMO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
Medicaid
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
Medicare Part A
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
Medicare Part B
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
POS
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
PPO
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78709
null
cpt
Nuclear medicine study of kidney with assessment of blood flow and function with or without drugs multiple studies
tricare
Workers Comp
O
1196.74
418.12
418.12
537.02
718.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
EPO
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
HMO
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
Medicaid
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
Medicare Part A
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
Medicare Part B
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
POS
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
PPO
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
aetna
Workers Comp
I
14425.56
5989.53
6419.86
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
EPO
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
HMO
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
Medicaid
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
Medicare Part A
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
Medicare Part B
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
POS
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
PPO
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield
Workers Comp
I
14425.56
5989.53
8613.39
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
EPO
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
HMO
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
Medicaid
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
Medicare Part A
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
Medicare Part B
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
POS
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
PPO
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
blue cross blue shield - medicare advantage
Workers Comp
I
14425.56
5989.53
5989.53
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
EPO
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
HMO
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
Medicaid
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
Medicare Part A
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
Medicare Part B
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
POS
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
PPO
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
788
null
ms-drg
C-Section delivery of baby
webtpa
Workers Comp
I
14425.56
5989.53
7144.90
8613.39
8655.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
EPO
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
HMO
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
Medicaid
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
Medicare Part A
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
Medicare Part B
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
POS
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
PPO
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78802
null
cpt
Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body single day imaging
tricare
Workers Comp
O
2849.28
1156.59
1156.59
1156.59
1709.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
EPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
HMO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
Medicaid
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
Medicare Part A
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
Medicare Part B
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
POS
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
PPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna
Workers Comp
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
EPO
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
HMO
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
Medicaid
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
Medicare Part A
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
Medicare Part B
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
POS
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
PPO
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
aetna - medicare advantage
Workers Comp
O
6713.61
1265.69
1265.69
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
EPO
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
HMO
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
Medicaid
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
Medicare Part A
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
Medicare Part B
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
POS
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
PPO
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield
Workers Comp
O
6713.61
1265.69
2584.26
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
EPO
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
HMO
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
Medicaid
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
Medicare Part A
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
Medicare Part B
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
POS
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
PPO
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
blue cross blue shield - medicare advantage
Workers Comp
O
6713.61
1265.69
2675.13
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
EPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
HMO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
Medicaid
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
Medicare Part A
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
Medicare Part B
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
POS
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
PPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
humana - medicare advantage
Workers Comp
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
EPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
HMO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
Medicaid
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
Medicare Part A
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
Medicare Part B
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
POS
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
PPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
tricare
Workers Comp
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
EPO
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
HMO
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
Medicaid
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
Medicare Part A
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
Medicare Part B
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
POS
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
PPO
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare
Workers Comp
O
6713.61
1265.69
4795.44
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
EPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
HMO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
Medicaid
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
Medicare Part A
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
Medicare Part B
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
POS
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
PPO
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
united healthcare - medicare advantage
Workers Comp
O
6713.61
1265.69
1278.40
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
EPO
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
HMO
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
Medicaid
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
Medicare Part A
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
Medicare Part B
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
POS
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
PPO
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78815
null
cpt
Nuclear medicine study with CT imaging skull base to mid-thigh
va
Workers Comp
O
6713.61
1265.69
1311.00
4795.44
4028.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
EPO
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
HMO
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
Medicaid
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
Medicare Part A
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
Medicare Part B
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
POS
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
PPO
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
blue cross blue shield
Workers Comp
O
7128.76
1294.73
2617.07
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
EPO
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
HMO
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
Medicaid
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
Medicare Part A
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
Medicare Part B
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
POS
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
PPO
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
humana - medicare advantage
Workers Comp
O
7128.76
1294.73
1311.05
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
EPO
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
HMO
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
Medicaid
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
Medicare Part A
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
Medicare Part B
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
POS
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
PPO
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
tricare
Workers Comp
O
7128.76
1294.73
1294.73
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
EPO
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
HMO
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
Medicaid
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
Medicare Part A
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
Medicare Part B
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
POS
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
PPO
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
va
Workers Comp
O
7128.76
1294.73
1311.00
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
EPO
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
HMO
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
Medicaid
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
Medicare Part A
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
Medicare Part B
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
POS
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
PPO
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
78816
null
cpt
Nuclear medicine study with CT imaging whole body
worker comp
Workers Comp
O
7128.76
1294.73
5091.98
5091.98
4277.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
EPO
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
HMO
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
Medicaid
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
Medicare Part A
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
Medicare Part B
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
POS
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
PPO
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79005
null
cpt
Oral administration of radioactive material therapy agent
blue cross blue shield - medicare advantage
Workers Comp
O
2406.30
494.33
494.33
494.33
1443.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
EPO
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
HMO
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
Medicaid
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
Medicare Part A
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
Medicare Part B
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
POS
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
PPO
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
79101
null
cpt
Radioactive material therapy into vein not radiolabeled
humana - medicare advantage
Workers Comp
O
548.70
210.31
210.31
210.31
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
EPO
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
HMO
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
Medicaid
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
Medicare Part A
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
Medicare Part B
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
POS
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
PPO
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
795
null
ms-drg
normal newborn
blue cross blue shield
Workers Comp
I
3362.80
2202.93
2202.93
2202.93
2017.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
EPO
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
HMO
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
Medicaid
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
Medicare Part A
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
Medicare Part B
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
POS
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
PPO
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield
Workers Comp
I
27667.32
7097.11
8098.90
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
POS
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
798
null
ms-drg
vaginal delivery with sterilization and/or d&c without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
27667.32
7097.11
7097.11
8098.90
16600.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
EPO
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
HMO
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
Medicaid
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
Medicare Part A
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
Medicare Part B
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
POS
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
PPO
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna
Workers Comp
O
66.10
8.46
37.15
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
EPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
HMO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
Medicaid
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
Medicare Part A
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
Medicare Part B
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
POS
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
PPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
aetna - medicare advantage
Workers Comp
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
EPO
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
HMO
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
Medicaid
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
Medicare Part A
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
Medicare Part B
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
POS
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
PPO
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield
Workers Comp
O
66.10
8.46
19.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
EPO
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
HMO
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
Medicaid
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
Medicare Part A
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
Medicare Part B
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
POS
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
PPO
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
blue cross blue shield - medicare advantage
Workers Comp
O
66.10
8.46
18.25
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
EPO
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
HMO
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
Medicaid
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
Medicare Part A
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
Medicare Part B
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
POS
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
PPO
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
cigna
Workers Comp
O
66.10
8.46
46.78
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
EPO
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
HMO
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
Medicaid
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
Medicare Part A
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
Medicare Part B
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
POS
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
PPO
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
healthchoice
Workers Comp
O
66.10
8.46
32.23
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
EPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
HMO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
Medicaid
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
Medicare Part A
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
Medicare Part B
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
POS
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
PPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
humana - medicare advantage
Workers Comp
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
EPO
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
HMO
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
Medicaid
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
Medicare Part A
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
Medicare Part B
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
POS
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
PPO
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
medica
Workers Comp
O
66.10
8.46
14.77
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
EPO
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
HMO
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
Medicaid
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
Medicare Part A
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
Medicare Part B
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
POS
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
PPO
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
tricare
Workers Comp
O
66.10
8.46
8.49
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
EPO
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
HMO
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
Medicaid
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
Medicare Part A
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
Medicare Part B
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
POS
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
PPO
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare
Workers Comp
O
66.10
8.46
47.22
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
EPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
HMO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
Medicaid
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
Medicare Part A
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
Medicare Part B
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
POS
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
PPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
united healthcare - medicare advantage
Workers Comp
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
EPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
HMO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
Medicaid
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
Medicare Part A
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
Medicare Part B
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
POS
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
PPO
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
va
Workers Comp
O
66.10
8.46
8.46
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
EPO
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
HMO
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
Medicaid
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
Medicare Part A
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
Medicare Part B
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
POS
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
PPO
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80048
null
cpt
Basic metabolic panel
webtpa
Workers Comp
O
66.10
8.46
44.07
47.22
10.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
EPO
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
HMO
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
Medicaid
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
Medicare Part A
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
Medicare Part B
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
POS
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
PPO
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield
Workers Comp
O
283.46
40.75
40.75
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
EPO
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
HMO
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
Medicaid
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
Medicare Part A
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
Medicare Part B
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
POS
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
PPO
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
blue cross blue shield - medicare advantage
Workers Comp
O
283.46
40.75
42.02
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
EPO
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
HMO
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
Medicaid
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
Medicare Part A
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
Medicare Part B
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
POS
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
PPO
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
healthchoice
Workers Comp
O
283.46
40.75
67.72
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
EPO
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
HMO
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
Medicaid
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
Medicare Part A
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
Medicare Part B
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
POS
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
PPO
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80050
null
cpt
General health panel
united healthcare
Workers Comp
O
283.46
40.75
202.48
202.48
61.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
EPO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
HMO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
Medicaid
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
Medicare Part A
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
Medicare Part B
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
POS
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
PPO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield
Workers Comp
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
EPO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
HMO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
Medicaid
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
Medicare Part A
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
Medicare Part B
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
POS
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
PPO
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
blue cross blue shield - medicare advantage
Workers Comp
O
61.43
7.01
30.33
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
EPO
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
HMO
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
Medicaid
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
Medicare Part A
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
Medicare Part B
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
POS
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
PPO
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
humana - medicare advantage
Workers Comp
O
61.43
7.01
7.01
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
EPO
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
HMO
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
Medicaid
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
Medicare Part A
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
Medicare Part B
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
POS
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
PPO
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80051
null
cpt
Blood test panel for electrolytes (sodium potassium chloride carbon dioxide)
webtpa
Workers Comp
O
61.43
7.01
43.00
43.00
36.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
EPO
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
HMO
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
Medicaid
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
Medicare Part A
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
Medicare Part B
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
POS
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
PPO
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna
Workers Comp
O
86.14
10.56
49.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
EPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
HMO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
Medicaid
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
Medicare Part A
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
Medicare Part B
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
POS
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
PPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
aetna - medicare advantage
Workers Comp
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
EPO
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
HMO
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
Medicaid
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
Medicare Part A
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
Medicare Part B
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
POS
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
PPO
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield
Workers Comp
O
86.14
10.56
16.94
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
EPO
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
HMO
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
Medicaid
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
Medicare Part A
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
Medicare Part B
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
POS
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
PPO
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
blue cross blue shield - medicare advantage
Workers Comp
O
86.14
10.56
17.12
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
EPO
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
HMO
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
Medicaid
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
Medicare Part A
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
Medicare Part B
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
POS
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
PPO
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
cigna
Workers Comp
O
86.14
10.56
60.96
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
EPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
HMO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
Medicaid
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
Medicare Part A
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
Medicare Part B
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
POS
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
PPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
geha
Workers Comp
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
EPO
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
HMO
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
Medicaid
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
Medicare Part A
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
Medicare Part B
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
POS
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
PPO
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
healthchoice
Workers Comp
O
86.14
10.56
43.57
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
EPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
HMO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
Medicaid
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
Medicare Part A
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
Medicare Part B
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
POS
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
PPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana
Workers Comp
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
EPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
HMO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
Medicaid
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
Medicare Part A
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
Medicare Part B
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
POS
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
PPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
humana - medicare advantage
Workers Comp
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
EPO
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
HMO
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
Medicaid
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
Medicare Part A
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
Medicare Part B
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
POS
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
PPO
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
medica
Workers Comp
O
86.14
10.56
31.87
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
EPO
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
HMO
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
Medicaid
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
Medicare Part A
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
Medicare Part B
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
POS
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
PPO
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
tricare
Workers Comp
O
86.14
10.56
10.60
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
EPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
HMO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
Medicaid
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
Medicare Part A
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
Medicare Part B
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
POS
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
PPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare
Workers Comp
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
EPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
HMO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
Medicaid
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
Medicare Part A
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
Medicare Part B
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
POS
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
PPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
united healthcare - medicare advantage
Workers Comp
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
EPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
HMO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
Medicaid
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
Medicare Part A
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
Medicare Part B
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
POS
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
PPO
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
va
Workers Comp
O
86.14
10.56
10.56
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
EPO
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
HMO
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
Medicaid
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
Medicare Part A
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
Medicare Part B
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
POS
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
PPO
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
webtpa
Workers Comp
O
86.14
10.56
57.43
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
EPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
HMO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
Medicaid
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
Medicare Part A
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
Medicare Part B
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
POS
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
PPO
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80053
null
cpt
Blood test comprehensive group of blood chemicals
worker comp
Workers Comp
O
86.14
10.56
61.53
61.53
12.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
EPO
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
HMO
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
Medicaid
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
Medicare Part A
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
Medicare Part B
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
POS
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
PPO
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80055
null
cpt
Obstetric blood test panel
va
Workers Comp
O
90.65
89.99
89.99
89.99
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
EPO
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
HMO
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
Medicaid
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
Medicare Part A
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
Medicare Part B
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
POS
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
PPO
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna
Workers Comp
O
136.10
8.96
61.58
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
EPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
HMO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
Medicaid
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
Medicare Part A
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
Medicare Part B
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
POS
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
PPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
aetna - medicare advantage
Workers Comp
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
EPO
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
HMO
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
Medicaid
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
Medicare Part A
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
Medicare Part B
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
POS
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
PPO
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield
Workers Comp
O
136.10
8.96
23.24
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
EPO
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
HMO
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
Medicaid
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
Medicare Part A
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
Medicare Part B
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
POS
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
PPO
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
blue cross blue shield - medicare advantage
Workers Comp
O
136.10
8.96
21.63
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
EPO
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
HMO
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
Medicaid
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
Medicare Part A
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
Medicare Part B
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
POS
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
PPO
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
cigna
Workers Comp
O
136.10
8.96
75.13
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
EPO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
HMO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
Medicaid
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
Medicare Part A
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
Medicare Part B
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
POS
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
PPO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
geha
Workers Comp
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
EPO
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
HMO
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
Medicaid
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
Medicare Part A
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
Medicare Part B
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
POS
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
PPO
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
healthchoice
Workers Comp
O
136.10
8.96
27.88
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
EPO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
HMO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
Medicaid
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
Medicare Part A
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
Medicare Part B
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
POS
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
PPO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana
Workers Comp
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
EPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
HMO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
Medicaid
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
Medicare Part A
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
Medicare Part B
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
POS
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
PPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
humana - medicare advantage
Workers Comp
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
EPO
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
HMO
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
Medicaid
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
Medicare Part A
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
Medicare Part B
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
POS
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
PPO
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
medica
Workers Comp
O
136.10
8.96
23.66
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
EPO
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
HMO
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
Medicaid
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
Medicare Part A
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
Medicare Part B
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
POS
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
PPO
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
tricare
Workers Comp
O
136.10
8.96
13.44
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
EPO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
HMO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
Medicaid
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
Medicare Part A
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
Medicare Part B
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
POS
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
PPO
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare
Workers Comp
O
136.10
8.96
102.07
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
EPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
HMO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
Medicaid
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
Medicare Part A
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
Medicare Part B
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
POS
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
PPO
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
united healthcare - medicare advantage
Workers Comp
O
136.10
8.96
13.39
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
EPO
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
HMO
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
Medicaid
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
Medicare Part A
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
Medicare Part B
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
POS
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
PPO
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
va
Workers Comp
O
136.10
8.96
8.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
EPO
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
HMO
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
Medicaid
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
Medicare Part A
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
Medicare Part B
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
POS
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
PPO
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
webtpa
Workers Comp
O
136.10
8.96
95.27
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
EPO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
HMO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
Medicaid
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
Medicare Part A
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
Medicare Part B
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
POS
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
PPO
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80061
null
cpt
Blood test lipids (cholesterol and triglycerides)
worker comp
Workers Comp
O
136.10
8.96
88.96
102.07
16.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
EPO
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
HMO
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
Medicaid
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
Medicare Part A
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
Medicare Part B
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
POS
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
PPO
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna
Workers Comp
O
63.76
8.68
36.98
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
EPO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
HMO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
Medicaid
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
Medicare Part A
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
Medicare Part B
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
POS
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
PPO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
aetna - medicare advantage
Workers Comp
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
EPO
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
HMO
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
Medicaid
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
Medicare Part A
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
Medicare Part B
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
POS
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
PPO
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield
Workers Comp
O
63.76
8.68
19.33
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
EPO
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
HMO
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
Medicaid
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
Medicare Part A
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
Medicare Part B
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
POS
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
PPO
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
blue cross blue shield - medicare advantage
Workers Comp
O
63.76
8.68
18.38
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
EPO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
HMO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
Medicaid
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
Medicare Part A
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
Medicare Part B
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
POS
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
PPO
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
humana - medicare advantage
Workers Comp
O
63.76
8.68
8.68
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
EPO
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
HMO
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
Medicaid
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
Medicare Part A
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
Medicare Part B
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
POS
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
PPO
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
tricare
Workers Comp
O
63.76
8.68
9.69
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
EPO
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
HMO
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
Medicaid
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
Medicare Part A
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
Medicare Part B
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
POS
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
PPO
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
united healthcare
Workers Comp
O
63.76
8.68
47.82
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
EPO
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
HMO
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
Medicaid
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
Medicare Part A
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
Medicare Part B
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
POS
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
PPO
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80069
null
cpt
Kidney function panel test
va
Workers Comp
O
63.76
8.68
12.07
47.82
10.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
EPO
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
HMO
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
Medicaid
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
Medicare Part A
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
Medicare Part B
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
POS
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
PPO
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna
Workers Comp
O
201.77
26.26
117.03
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
EPO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
HMO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
Medicaid
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
Medicare Part A
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
Medicare Part B
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
POS
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
PPO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
aetna - medicare advantage
Workers Comp
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
EPO
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
HMO
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
Medicaid
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
Medicare Part A
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
Medicare Part B
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
POS
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
PPO
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield
Workers Comp
O
201.77
26.26
30.33
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
EPO
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
HMO
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
Medicaid
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
Medicare Part A
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
Medicare Part B
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
POS
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
PPO
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
blue cross blue shield - medicare advantage
Workers Comp
O
201.77
26.26
26.26
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
EPO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
HMO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
Medicaid
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
Medicare Part A
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
Medicare Part B
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
POS
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
PPO
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
humana - medicare advantage
Workers Comp
O
201.77
26.26
47.63
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
EPO
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
HMO
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
Medicaid
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
Medicare Part A
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
Medicare Part B
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
POS
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
PPO
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
medica
Workers Comp
O
201.77
26.26
74.65
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
EPO
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
HMO
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
Medicaid
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
Medicare Part A
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
Medicare Part B
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
POS
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
PPO
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
tricare
Workers Comp
O
201.77
26.26
47.83
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
EPO
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
HMO
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
Medicaid
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
Medicare Part A
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
Medicare Part B
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
POS
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
PPO
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
united healthcare
Workers Comp
O
201.77
26.26
144.13
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
EPO
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
HMO
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
Medicaid
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
Medicare Part A
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
Medicare Part B
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
POS
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
PPO
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
va
Workers Comp
O
201.77
26.26
31.89
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
EPO
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
HMO
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
Medicaid
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
Medicare Part A
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
Medicare Part B
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
POS
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
PPO
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80074
null
cpt
Acute hepatitis panel
webtpa
Workers Comp
O
201.77
26.26
137.88
144.13
57.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
EPO
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
HMO
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
Medicaid
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
Medicare Part A
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
Medicare Part B
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
POS
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
PPO
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna
Workers Comp
O
66.10
8.17
37.15
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
EPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
HMO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
Medicaid
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
Medicare Part A
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
Medicare Part B
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
POS
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
PPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
aetna - medicare advantage
Workers Comp
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
EPO
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
HMO
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
Medicaid
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
Medicare Part A
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
Medicare Part B
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
POS
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
PPO
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield
Workers Comp
O
66.10
8.17
15.83
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
EPO
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
HMO
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
Medicaid
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
Medicare Part A
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
Medicare Part B
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
POS
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
PPO
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
blue cross blue shield - medicare advantage
Workers Comp
O
66.10
8.17
14.39
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
EPO
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
HMO
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
Medicaid
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
Medicare Part A
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
Medicare Part B
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
POS
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
PPO
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
cigna
Workers Comp
O
66.10
8.17
46.78
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
EPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
HMO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
Medicaid
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
Medicare Part A
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
Medicare Part B
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
POS
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
PPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
humana - medicare advantage
Workers Comp
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
EPO
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
HMO
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
Medicaid
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
Medicare Part A
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
Medicare Part B
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
POS
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
PPO
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
tricare
Workers Comp
O
66.10
8.17
8.20
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
EPO
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
HMO
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
Medicaid
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
Medicare Part A
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
Medicare Part B
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
POS
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
PPO
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare
Workers Comp
O
66.10
8.17
47.22
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
EPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
HMO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
Medicaid
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
Medicare Part A
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
Medicare Part B
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
POS
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
PPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
united healthcare - medicare advantage
Workers Comp
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
EPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
HMO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
Medicaid
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
Medicare Part A
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
Medicare Part B
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
POS
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
PPO
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
va
Workers Comp
O
66.10
8.17
8.17
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
EPO
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
HMO
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
Medicaid
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
Medicare Part A
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
Medicare Part B
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
POS
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
PPO
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80076
null
cpt
Liver function blood test panel
webtpa
Workers Comp
O
66.10
8.17
46.27
47.22
9.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
EPO
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
HMO
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
Medicaid
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
Medicare Part A
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
Medicare Part B
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
POS
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
PPO
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
801
null
ms-drg
splenectomy without cc/mcc
tricare
Workers Comp
I
39047.29
7704.58
7704.58
7704.58
23428.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
EPO
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
HMO
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
Medicaid
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
Medicare Part A
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
Medicare Part B
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
POS
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
PPO
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80145
null
cpt
Measurement of adalimumab
tricare
Workers Comp
O
96.43
38.73
38.73
38.73
57.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
EPO
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
HMO
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
Medicaid
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
Medicare Part A
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
Medicare Part B
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
POS
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
PPO
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
blue cross blue shield
Workers Comp
O
102.39
13.38
13.38
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
EPO
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
HMO
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
Medicaid
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
Medicare Part A
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
Medicare Part B
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
POS
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
PPO
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80156
null
cpt
Carbamazepine level total
humana - medicare advantage
Workers Comp
O
102.39
13.38
14.57
14.57
61.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
EPO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
HMO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
Medicaid
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
Medicare Part A
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
Medicare Part B
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
POS
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
PPO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna
Workers Comp
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
EPO
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
HMO
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
Medicaid
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
Medicare Part A
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
Medicare Part B
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
POS
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
PPO
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
aetna - medicare advantage
Workers Comp
O
95.60
13.28
17.40
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
EPO
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
HMO
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
Medicaid
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
Medicare Part A
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
Medicare Part B
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
POS
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
PPO
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield
Workers Comp
O
95.60
13.28
15.53
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
EPO
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
HMO
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
Medicaid
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
Medicare Part A
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
Medicare Part B
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
POS
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
PPO
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
blue cross blue shield - medicare advantage
Workers Comp
O
95.60
13.28
50.03
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
EPO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
HMO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
Medicaid
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
Medicare Part A
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
Medicare Part B
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
POS
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
PPO
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
humana - medicare advantage
Workers Comp
O
95.60
13.28
13.28
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
EPO
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
HMO
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
Medicaid
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
Medicare Part A
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
Medicare Part B
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
POS
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
PPO
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80162
null
cpt
Digoxin level total
tricare
Workers Comp
O
95.60
13.28
13.33
50.03
15.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
EPO
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
HMO
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
Medicaid
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
Medicare Part A
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
Medicare Part B
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
POS
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
PPO
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield
Workers Comp
O
115.63
9.07
36.55
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
EPO
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
HMO
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
Medicaid
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
Medicare Part A
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
Medicare Part B
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
POS
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
PPO
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
blue cross blue shield - medicare advantage
Workers Comp
O
115.63
9.07
47.22
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
EPO
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
HMO
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
Medicaid
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
Medicare Part A
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
Medicare Part B
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
POS
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
PPO
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
humana - medicare advantage
Workers Comp
O
115.63
9.07
13.54
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
EPO
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
HMO
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
Medicaid
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
Medicare Part A
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
Medicare Part B
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
POS
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
PPO
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
tricare
Workers Comp
O
115.63
9.07
13.60
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
EPO
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
HMO
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
Medicaid
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
Medicare Part A
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
Medicare Part B
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
POS
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
PPO
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80164
null
cpt
Valproic acid level total
va
Workers Comp
O
115.63
9.07
9.07
47.22
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
EPO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
HMO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
Medicaid
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
Medicare Part A
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
Medicare Part B
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
POS
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
PPO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
aetna - medicare advantage
Workers Comp
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
EPO
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
HMO
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
Medicaid
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
Medicare Part A
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
Medicare Part B
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
POS
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
PPO
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield
Workers Comp
O
67.89
13.25
37.16
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
EPO
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
HMO
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
Medicaid
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
POS
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
PPO
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
13.25
20.97
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
EPO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
HMO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
Medicaid
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
Medicare Part A
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
Medicare Part B
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
POS
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
PPO
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
humana - medicare advantage
Workers Comp
O
67.89
13.25
13.25
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
EPO
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
HMO
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
Medicaid
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
Medicare Part A
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
Medicare Part B
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
POS
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
PPO
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80177
null
cpt
Levetiracetam level
united healthcare - medicare advantage
Workers Comp
O
67.89
13.25
14.50
37.16
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
EPO
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
HMO
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
Medicaid
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
Medicare Part A
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
Medicare Part B
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
POS
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
PPO
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield
Workers Comp
O
53.08
6.61
14.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
EPO
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
HMO
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
Medicaid
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
Medicare Part A
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
Medicare Part B
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
POS
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
PPO
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
blue cross blue shield - medicare advantage
Workers Comp
O
53.08
6.61
12.96
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
EPO
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
HMO
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
Medicaid
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
Medicare Part A
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
Medicare Part B
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
POS
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
PPO
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
cigna
Workers Comp
O
53.08
6.61
37.57
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
EPO
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
HMO
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
Medicaid
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
Medicare Part A
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
Medicare Part B
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
POS
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
PPO
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80178
null
cpt
Lithium level
humana - medicare advantage
Workers Comp
O
53.08
6.61
6.61
37.57
7.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
EPO
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
HMO
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
Medicaid
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
Medicare Part A
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
Medicare Part B
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
POS
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
PPO
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80180
null
cpt
Mycophenolate (mycophenolic acid) level
blue cross blue shield - medicare advantage
Workers Comp
O
483.70
43.51
43.51
43.51
290.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
EPO
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
HMO
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
Medicaid
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
Medicare Part A
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
Medicare Part B
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
POS
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
PPO
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80183
null
cpt
Oxcarbazepine level
blue cross blue shield
Workers Comp
O
67.89
7.52
7.52
7.52
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
EPO
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
HMO
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
Medicaid
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
Medicare Part A
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
Medicare Part B
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
POS
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
PPO
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80184
null
cpt
Phenobarbital level
blue cross blue shield
Workers Comp
O
95.60
17.41
17.41
17.41
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
EPO
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
HMO
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
Medicaid
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
Medicare Part A
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
Medicare Part B
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
POS
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
PPO
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
blue cross blue shield
Workers Comp
O
102.39
13.25
16.57
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
EPO
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
HMO
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
Medicaid
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
Medicare Part A
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
Medicare Part B
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
POS
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
PPO
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80185
null
cpt
Phenytoin level total
humana - medicare advantage
Workers Comp
O
102.39
13.25
13.25
16.57
15.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
EPO
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
HMO
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
Medicaid
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
Medicare Part A
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
Medicare Part B
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
POS
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
PPO
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield
Workers Comp
O
636.63
13.73
67.75
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
EPO
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
HMO
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
Medicaid
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
Medicare Part A
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
Medicare Part B
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
POS
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
PPO
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
blue cross blue shield - medicare advantage
Workers Comp
O
636.63
13.73
45.43
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
EPO
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
HMO
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
Medicaid
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
Medicare Part A
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
Medicare Part B
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
POS
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
PPO
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
humana - medicare advantage
Workers Comp
O
636.63
13.73
13.73
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
EPO
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
HMO
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
Medicaid
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
Medicare Part A
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
Medicare Part B
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
POS
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
PPO
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80197
null
cpt
Tacrolimus level
worker comp
Workers Comp
O
636.63
13.73
454.74
454.74
16.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
EPO
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
HMO
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
Medicaid
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
Medicare Part A
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
Medicare Part B
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
POS
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
PPO
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80198
null
cpt
Theophylline level
humana - medicare advantage
Workers Comp
O
93.49
14.14
14.14
14.14
56.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
EPO
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
HMO
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
Medicaid
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
Medicare Part A
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
Medicare Part B
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
POS
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
PPO
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield
Workers Comp
O
82.58
13.54
33.21
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
EPO
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
HMO
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
Medicaid
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
Medicare Part A
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
Medicare Part B
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
POS
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
PPO
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
blue cross blue shield - medicare advantage
Workers Comp
O
82.58
13.54
36.28
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
EPO
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
HMO
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
Medicaid
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
Medicare Part A
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
Medicare Part B
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
POS
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
PPO
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
cigna
Workers Comp
O
82.58
13.54
58.44
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
EPO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
HMO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
Medicaid
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
Medicare Part A
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
Medicare Part B
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
POS
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
PPO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
humana - medicare advantage
Workers Comp
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
EPO
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
HMO
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
Medicaid
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
Medicare Part A
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
Medicare Part B
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
POS
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
PPO
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
tricare
Workers Comp
O
82.58
13.54
13.60
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
EPO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
HMO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
Medicaid
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
Medicare Part A
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
Medicare Part B
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
POS
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
PPO
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80202
null
cpt
Vancomycin (antibiotic) level
united healthcare - medicare advantage
Workers Comp
O
82.58
13.54
13.54
58.44
16.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
EPO
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
HMO
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
Medicaid
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
Medicare Part A
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
Medicare Part B
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
POS
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
PPO
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80230
null
cpt
Measurement of infliximab
blue cross blue shield
Workers Comp
O
93.12
12.63
12.63
12.63
55.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
EPO
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
HMO
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
Medicaid
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
Medicare Part A
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
Medicare Part B
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
POS
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
PPO
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield
Workers Comp
O
32.27
5.44
13.63
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
EPO
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
HMO
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
Medicaid
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
Medicare Part A
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
Medicare Part B
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
POS
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
PPO
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
blue cross blue shield - medicare advantage
Workers Comp
O
32.27
5.44
5.44
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
EPO
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
HMO
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
Medicaid
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
Medicare Part A
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
Medicare Part B
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
POS
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
PPO
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
humana - medicare advantage
Workers Comp
O
32.27
5.44
18.64
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
EPO
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
HMO
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
Medicaid
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
Medicare Part A
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
Medicare Part B
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
POS
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
PPO
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80299
null
cpt
Quantitation of therapeutic drug
tricare
Workers Comp
O
32.27
5.44
18.72
18.72
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
EPO
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
HMO
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
Medicaid
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
Medicare Part A
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
Medicare Part B
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
POS
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
PPO
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
aetna
Workers Comp
O
484.15
10.33
280.81
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
EPO
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
HMO
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
Medicaid
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
Medicare Part A
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
Medicare Part B
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
POS
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
PPO
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield
Workers Comp
O
484.15
10.33
35.18
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
EPO
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
HMO
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
Medicaid
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
Medicare Part A
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
Medicare Part B
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
POS
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
PPO
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
blue cross blue shield - medicare advantage
Workers Comp
O
484.15
10.33
36.62
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
EPO
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
HMO
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
Medicaid
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
Medicare Part A
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
Medicare Part B
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
POS
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
PPO
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
humana - medicare advantage
Workers Comp
O
484.15
10.33
17.14
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
EPO
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
HMO
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
Medicaid
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
Medicare Part A
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
Medicare Part B
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
POS
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
PPO
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
tricare
Workers Comp
O
484.15
10.33
17.21
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
EPO
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
HMO
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
Medicaid
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
Medicare Part A
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
Medicare Part B
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
POS
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
PPO
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare
Workers Comp
O
484.15
10.33
345.82
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
EPO
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
HMO
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
Medicaid
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
Medicare Part A
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
Medicare Part B
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
POS
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
PPO
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
united healthcare - medicare advantage
Workers Comp
O
484.15
10.33
16.99
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
EPO
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
HMO
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
Medicaid
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
Medicare Part A
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
Medicare Part B
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
POS
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
PPO
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
va
Workers Comp
O
484.15
10.33
10.33
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
EPO
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
HMO
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
Medicaid
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
Medicare Part A
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
Medicare Part B
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
POS
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
PPO
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80306
null
cpt
Testing for presence of drug read by instrument assisted observation
webtpa
Workers Comp
O
484.15
10.33
322.77
345.82
20.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
EPO
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
HMO
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
Medicaid
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
Medicare Part A
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
Medicare Part B
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
POS
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
PPO
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
blue cross blue shield
Workers Comp
O
197.60
62.14
73.03
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
EPO
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
HMO
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
Medicaid
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
Medicare Part A
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
Medicare Part B
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
POS
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
PPO
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80307
null
cpt
Testing for presence of drug by chemistry analyzers
humana - medicare advantage
Workers Comp
O
197.60
62.14
62.14
73.03
118.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
EPO
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
HMO
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
Medicaid
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
Medicare Part A
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
Medicare Part B
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
POS
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
PPO
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80320
null
cpt
Alcohols levels
blue cross blue shield - medicare advantage
Workers Comp
O
167.64
9.53
9.53
9.53
100.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
EPO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
HMO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
Medicaid
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
Medicare Part A
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
Medicare Part B
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
POS
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
PPO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield
Workers Comp
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
EPO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
HMO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
Medicaid
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part A
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part B
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
POS
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
PPO
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80321
null
cpt
Alcohols levels 1 or 2
blue cross blue shield - medicare advantage
Workers Comp
O
250.77
7.05
7.05
7.05
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
EPO
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
HMO
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
Medicaid
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
Medicare Part A
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
Medicare Part B
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
POS
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
PPO
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield
Workers Comp
O
250.77
4.01
4.97
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
EPO
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
HMO
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
Medicaid
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part A
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part B
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
POS
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
PPO
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80324
null
cpt
Amphetamines levels 1 or 2
blue cross blue shield - medicare advantage
Workers Comp
O
250.77
4.01
4.01
4.97
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
EPO
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
HMO
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
Medicaid
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part A
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
Medicare Part B
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
POS
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
PPO
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80329
null
cpt
Analgesics levels 1 or 2
blue cross blue shield - medicare advantage
Workers Comp
O
177.52
10.22
10.22
10.22
106.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
EPO
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
HMO
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
Medicaid
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
Medicare Part A
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
Medicare Part B
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
POS
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
PPO
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield
Workers Comp
O
250.77
4.01
6.44
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
EPO
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
HMO
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
Medicaid
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
Medicare Part A
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
Medicare Part B
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
POS
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
PPO
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80335
null
cpt
Antidepressants levels 1 or 2 (tricyclic and other cyclicals)
blue cross blue shield - medicare advantage
Workers Comp
O
250.77
4.01
4.01
6.44
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
EPO
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
HMO
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
Medicaid
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
Medicare Part A
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
Medicare Part B
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
POS
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
PPO
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield
Workers Comp
O
250.77
4.67
6.03
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
EPO
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
HMO
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
Medicaid
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
Medicare Part A
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
Medicare Part B
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
POS
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
PPO
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80345
null
cpt
Barbiturates levels
blue cross blue shield - medicare advantage
Workers Comp
O
250.77
4.67
4.67
6.03
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
EPO
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
HMO
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
Medicaid
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
Medicare Part A
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
Medicare Part B
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
POS
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
PPO
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield
Workers Comp
O
83.47
2.34
2.35
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
EPO
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
HMO
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
Medicaid
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
Medicare Part A
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
Medicare Part B
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
POS
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
PPO
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80346
null
cpt
Benzodiazepines levels 1-12
blue cross blue shield - medicare advantage
Workers Comp
O
83.47
2.34
2.34
2.35
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
EPO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
HMO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
Medicaid
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
Medicare Part A
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
Medicare Part B
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
POS
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
PPO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield
Workers Comp
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
EPO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
HMO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
Medicaid
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
Medicare Part A
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
Medicare Part B
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
POS
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
PPO
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80348
null
cpt
Buprenorphine level
blue cross blue shield - medicare advantage
Workers Comp
O
250.29
6.02
6.02
6.02
150.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
EPO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
HMO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
Medicaid
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
Medicare Part A
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
Medicare Part B
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
POS
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
PPO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield
Workers Comp
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
EPO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
HMO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
Medicaid
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
Medicare Part A
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
Medicare Part B
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
POS
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
PPO
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80349
null
cpt
Cannabinoids levels natural
blue cross blue shield - medicare advantage
Workers Comp
O
106.74
3.00
3.00
3.00
64.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
EPO
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
HMO
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
Medicaid
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
Medicare Part A
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
Medicare Part B
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
POS
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
PPO
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80354
null
cpt
Fentanyl level
blue cross blue shield
Workers Comp
O
298.28
7.33
7.33
7.33
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
EPO
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
HMO
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
Medicaid
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
Medicare Part A
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
Medicare Part B
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
POS
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
PPO
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield
Workers Comp
O
298.28
5.44
5.44
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
EPO
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
HMO
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
Medicaid
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
Medicare Part A
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
Medicare Part B
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
POS
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
PPO
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80355
null
cpt
Gabapentin level non-blood
blue cross blue shield - medicare advantage
Workers Comp
O
298.28
5.44
6.68
6.68
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
EPO
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
HMO
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
Medicaid
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
Medicare Part A
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
Medicare Part B
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
POS
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
PPO
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80358
null
cpt
Methadone level
blue cross blue shield
Workers Comp
O
250.77
5.09
5.09
5.09
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
EPO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
HMO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
Medicaid
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
Medicare Part A
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
Medicare Part B
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
POS
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
PPO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield
Workers Comp
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
EPO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
HMO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
Medicaid
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
Medicare Part A
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
Medicare Part B
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
POS
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
PPO
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
blue cross blue shield - medicare advantage
Workers Comp
O
71.23
2.00
2.00
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
EPO
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
HMO
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
Medicaid
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
Medicare Part A
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
Medicare Part B
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
POS
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
PPO
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80361
null
cpt
Opiates levels
va
Workers Comp
O
71.23
2.00
67.84
67.84
42.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
EPO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
HMO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
Medicaid
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
Medicare Part A
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
Medicare Part B
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
POS
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
PPO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield
Workers Comp
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
EPO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
HMO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
Medicaid
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
Medicare Part A
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
Medicare Part B
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
POS
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
PPO
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80365
null
cpt
Oxycodone levels
blue cross blue shield - medicare advantage
Workers Comp
O
71.96
2.02
2.02
2.02
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
EPO
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
HMO
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
Medicaid
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
Medicare Part A
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
Medicare Part B
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
POS
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
PPO
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80366
null
cpt
Pregabalin level
blue cross blue shield
Workers Comp
O
298.28
5.94
5.94
5.94
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
EPO
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
HMO
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
Medicaid
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
Medicare Part A
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
Medicare Part B
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
POS
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
PPO
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield
Workers Comp
O
298.28
7.18
8.70
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
EPO
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
HMO
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
Medicaid
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
Medicare Part A
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
Medicare Part B
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
POS
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
PPO
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80373
null
cpt
Tramadol level
blue cross blue shield - medicare advantage
Workers Comp
O
298.28
7.18
7.18
8.70
178.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
EPO
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
HMO
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
Medicaid
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
Medicare Part A
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
Medicare Part B
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
POS
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
PPO
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
80374
null
cpt
Stereoisomer (enantiomer) drug analysis
blue cross blue shield
Workers Comp
O
250.77
4.72
4.72
4.72
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
EPO
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
HMO
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
Medicaid
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
Medicare Part A
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
Medicare Part B
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
POS
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
PPO
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
aetna
Workers Comp
I
15424.00
3573.12
4844.39
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
EPO
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
HMO
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
Medicaid
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
Medicare Part A
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
Medicare Part B
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
POS
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
PPO
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield
Workers Comp
I
15424.00
3573.12
9784.86
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
EPO
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
HMO
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
Medicaid
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
POS
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
PPO
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
15424.00
3573.12
8403.54
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
EPO
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
HMO
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
Medicaid
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
Medicare Part A
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
Medicare Part B
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
POS
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
PPO
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
tricare
Workers Comp
I
15424.00
3573.12
3573.12
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
EPO
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
HMO
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
Medicaid
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
Medicare Part A
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
Medicare Part B
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
POS
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
PPO
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
united healthcare
Workers Comp
I
15424.00
3573.12
10065.37
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
EPO
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
HMO
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
Medicaid
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
Medicare Part A
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
Medicare Part B
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
POS
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
PPO
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
805
null
ms-drg
vaginal delivery without sterilization or d&c with mcc
webtpa
Workers Comp
I
15424.00
3573.12
14086.14
14086.14
9254.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
EPO
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
HMO
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
Medicaid
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
Medicare Part A
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
Medicare Part B
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
POS
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
PPO
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield
Workers Comp
I
12565.06
2859.80
6006.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
EPO
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
HMO
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
Medicaid
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
Medicare Part A
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
Medicare Part B
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
POS
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
PPO
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
blue cross blue shield - medicare advantage
Workers Comp
I
12565.06
2859.80
5809.88
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
EPO
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
HMO
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
Medicaid
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
Medicare Part A
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
Medicare Part B
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
POS
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
PPO
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
tricare
Workers Comp
I
12565.06
2859.80
2859.80
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
EPO
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
HMO
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
Medicaid
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
Medicare Part A
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
Medicare Part B
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
POS
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
PPO
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
806
null
ms-drg
vaginal delivery without sterilization or d&c with cc
webtpa
Workers Comp
I
12565.06
2859.80
5165.89
6006.80
7539.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
EPO
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
HMO
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
Medicaid
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
Medicare Part A
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
Medicare Part B
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
POS
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
PPO
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
aetna
Workers Comp
I
11756.79
2546.76
5755.39
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
EPO
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
HMO
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
Medicaid
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
Medicare Part A
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
Medicare Part B
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
POS
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
PPO
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield
Workers Comp
I
11756.79
2546.76
5871.68
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
EPO
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
HMO
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
Medicaid
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
Medicare Part A
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
Medicare Part B
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
POS
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
PPO
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
blue cross blue shield - medicare advantage
Workers Comp
I
11756.79
2546.76
5168.65
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
EPO
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
HMO
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
Medicaid
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
Medicare Part A
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
Medicare Part B
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
POS
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
PPO
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
cigna
Workers Comp
I
11756.79
2546.76
8071.15
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
EPO
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
HMO
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
Medicaid
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
Medicare Part A
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
Medicare Part B
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
POS
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
PPO
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
humana - medicare advantage
Workers Comp
I
11756.79
2546.76
4626.86
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
EPO
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
HMO
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
Medicaid
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
Medicare Part A
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
Medicare Part B
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
POS
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
PPO
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
tricare
Workers Comp
I
11756.79
2546.76
2546.76
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
EPO
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
HMO
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
Medicaid
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
Medicare Part A
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
Medicare Part B
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
POS
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
PPO
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
united healthcare
Workers Comp
I
11756.79
2546.76
6913.05
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
EPO
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
HMO
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
Medicaid
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
Medicare Part A
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
Medicare Part B
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
POS
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
PPO
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
va
Workers Comp
I
11756.79
2546.76
4902.85
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
EPO
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
HMO
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
Medicaid
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
Medicare Part A
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
Medicare Part B
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
POS
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
PPO
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
807
null
ms-drg
Normal delivery of baby
webtpa
Workers Comp
I
11756.79
2546.76
7178.56
8071.15
7054.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
EPO
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
HMO
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
Medicaid
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
Medicare Part A
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
Medicare Part B
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
POS
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
PPO
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
809
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc
blue cross blue shield
Workers Comp
I
27974.33
12390.44
12390.44
12390.44
16784.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
EPO
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
HMO
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
Medicaid
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
Medicare Part A
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
Medicare Part B
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
POS
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
PPO
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
810
null
ms-drg
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc
blue cross blue shield
Workers Comp
I
36700.41
8994.96
8994.96
8994.96
22020.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
EPO
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
HMO
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
Medicaid
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
Medicare Part A
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
Medicare Part B
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
POS
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
PPO
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81000
null
cpt
Manual urinalysis test with examination using microscope
blue cross blue shield
Workers Comp
O
12.00
3.09
3.09
3.09
7.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
EPO
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
HMO
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
Medicaid
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
Medicare Part A
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
Medicare Part B
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
POS
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
PPO
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna
Workers Comp
O
13.02
1.50
7.55
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
EPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
HMO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
Medicaid
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
Medicare Part A
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
Medicare Part B
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
POS
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
PPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
aetna - medicare advantage
Workers Comp
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
EPO
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
HMO
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
Medicaid
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
Medicare Part A
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
Medicare Part B
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
POS
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
PPO
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield
Workers Comp
O
13.02
1.50
2.79
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
EPO
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
HMO
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
Medicaid
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
Medicare Part A
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
Medicare Part B
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
POS
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
PPO
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
blue cross blue shield - medicare advantage
Workers Comp
O
13.02
1.50
2.56
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
EPO
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
HMO
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
Medicaid
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
Medicare Part A
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
Medicare Part B
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
POS
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
PPO
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
cigna
Workers Comp
O
13.02
1.50
9.21
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
EPO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
HMO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
Medicaid
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
Medicare Part A
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
Medicare Part B
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
POS
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
PPO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
geha
Workers Comp
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
EPO
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
HMO
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
Medicaid
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
Medicare Part A
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
Medicare Part B
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
POS
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
PPO
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
healthchoice
Workers Comp
O
13.02
1.50
3.51
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
EPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
HMO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
Medicaid
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
Medicare Part A
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
Medicare Part B
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
POS
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
PPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
humana - medicare advantage
Workers Comp
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
EPO
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
HMO
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
Medicaid
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
Medicare Part A
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
Medicare Part B
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
POS
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
PPO
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
tricare
Workers Comp
O
13.02
1.50
2.26
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
EPO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
HMO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
Medicaid
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
Medicare Part A
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
Medicare Part B
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
POS
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
PPO
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare
Workers Comp
O
13.02
1.50
9.30
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
EPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
HMO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
Medicaid
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
Medicare Part A
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
Medicare Part B
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
POS
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
PPO
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
united healthcare - medicare advantage
Workers Comp
O
13.02
1.50
2.25
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
EPO
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
HMO
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
Medicaid
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
Medicare Part A
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
Medicare Part B
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
POS
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
PPO
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
va
Workers Comp
O
13.02
1.50
1.50
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
EPO
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
HMO
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
Medicaid
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
Medicare Part A
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
Medicare Part B
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
POS
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
PPO
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81003
null
cpt
Automated urinalysis test b
webtpa
Workers Comp
O
13.02
1.50
8.68
9.30
2.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
EPO
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
HMO
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
Medicaid
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
Medicare Part A
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
Medicare Part B
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
POS
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
PPO
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
aetna
Workers Comp
O
28.38
2.92
17.15
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
EPO
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
HMO
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
Medicaid
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
Medicare Part A
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
Medicare Part B
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
POS
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
PPO
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield
Workers Comp
O
28.38
2.92
5.79
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
EPO
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
HMO
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
Medicaid
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
POS
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
PPO
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
blue cross blue shield - medicare advantage
Workers Comp
O
28.38
2.92
5.98
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
EPO
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
HMO
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
Medicaid
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
Medicare Part A
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
Medicare Part B
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
POS
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
PPO
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
humana - medicare advantage
Workers Comp
O
28.38
2.92
3.64
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
EPO
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
HMO
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
Medicaid
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
Medicare Part A
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
Medicare Part B
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
POS
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
PPO
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
tricare
Workers Comp
O
28.38
2.92
3.65
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
EPO
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
HMO
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
Medicaid
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
Medicare Part A
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
Medicare Part B
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
POS
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
PPO
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
united healthcare
Workers Comp
O
28.38
2.92
20.28
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
EPO
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
HMO
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
Medicaid
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
Medicare Part A
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
Medicare Part B
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
POS
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
PPO
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81050
null
cpt
Urine volume measurement
va
Workers Comp
O
28.38
2.92
2.92
20.28
4.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
EPO
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
HMO
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
Medicaid
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
Medicare Part A
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
Medicare Part B
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
POS
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
PPO
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
aetna - medicare advantage
Workers Comp
I
28884.26
6276.26
9423.99
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
EPO
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
HMO
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
Medicaid
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
Medicare Part A
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
Medicare Part B
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
POS
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
PPO
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
blue cross blue shield
Workers Comp
I
28884.26
6276.26
10985.71
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
EPO
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
HMO
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
Medicaid
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
Medicare Part A
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
Medicare Part B
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
POS
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
PPO
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
humana - medicare advantage
Workers Comp
I
28884.26
6276.26
8514.33
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
EPO
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
HMO
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
Medicaid
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
Medicare Part A
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
Medicare Part B
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
POS
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
PPO
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
811
null
ms-drg
red blood cell disorders with mcc
va
Workers Comp
I
28884.26
6276.26
6276.26
10985.71
17330.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
EPO
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
HMO
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
Medicaid
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
Medicare Part A
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
Medicare Part B
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
POS
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
PPO
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
aetna - medicare advantage
Workers Comp
I
20507.85
4470.43
6332.79
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
EPO
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
HMO
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
Medicaid
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
Medicare Part A
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
Medicare Part B
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
POS
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
PPO
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield
Workers Comp
I
20507.85
4470.43
8288.87
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
EPO
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
HMO
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
Medicaid
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
POS
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
PPO
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
20507.85
4470.43
8653.21
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
EPO
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
HMO
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
Medicaid
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
Medicare Part A
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
Medicare Part B
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
POS
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
PPO
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
humana - medicare advantage
Workers Comp
I
20507.85
4470.43
5047.51
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
EPO
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
HMO
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
Medicaid
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
Medicare Part A
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
Medicare Part B
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
POS
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
PPO
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
tricare
Workers Comp
I
20507.85
4470.43
4470.43
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
EPO
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
HMO
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
Medicaid
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
Medicare Part A
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
Medicare Part B
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
POS
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
PPO
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
812
null
ms-drg
red blood cell disorders without mcc
va
Workers Comp
I
20507.85
4470.43
5849.60
8653.21
12304.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
EPO
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
HMO
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
Medicaid
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
Medicare Part A
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
Medicare Part B
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
POS
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
PPO
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81240
null
cpt
Gene analysis (prothrombin coagulation factor II) A variant
tricare
Workers Comp
O
25.44
25.44
25.44
25.44
15.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
EPO
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
HMO
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
Medicaid
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
Medicare Part A
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
Medicare Part B
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
POS
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
PPO
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81241
null
cpt
Gene analysis (coagulation factor V) Leiden variant
tricare
Workers Comp
O
297.86
73.67
73.67
73.67
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
EPO
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
HMO
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
Medicaid
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
Medicare Part A
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
Medicare Part B
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
POS
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
PPO
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81256
null
cpt
Gene analysis (hemochromatosis) common variants
blue cross blue shield
Workers Comp
O
335.01
62.49
62.49
62.49
201.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
EPO
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
HMO
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
Medicaid
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
Medicare Part A
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
Medicare Part B
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
POS
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
PPO
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81400
null
cpt
Molecular pathology procedure level 1
blue cross blue shield
Workers Comp
O
159.00
159.00
159.00
159.00
95.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
EPO
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
HMO
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
Medicaid
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
Medicare Part A
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
Medicare Part B
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
POS
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
PPO
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81403
null
cpt
Molecular pathology procedure level 4
va
Workers Comp
O
786.38
185.20
185.20
185.20
471.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
EPO
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
HMO
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
Medicaid
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
Medicare Part A
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
Medicare Part B
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
POS
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
PPO
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
81479
null
cpt
Molecular pathology procedure
va
Workers Comp
O
70.88
71.75
71.75
71.75
42.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
EPO
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
HMO
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
Medicaid
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
Medicare Part A
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
Medicare Part B
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
POS
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
PPO
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
819
null
ms-drg
other antepartum diagnoses with o.r. procedures without cc/mcc
tricare
Workers Comp
I
28789.87
5314.57
5314.57
5314.57
17273.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
EPO
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
HMO
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
Medicaid
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
Medicare Part A
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
Medicare Part B
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
POS
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
PPO
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
blue cross blue shield
Workers Comp
O
74.94
8.17
16.29
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
EPO
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
HMO
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
Medicaid
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
Medicare Part A
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
Medicare Part B
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
POS
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
PPO
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
humana - medicare advantage
Workers Comp
O
74.94
8.17
8.17
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
EPO
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
HMO
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
Medicaid
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
Medicare Part A
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
Medicare Part B
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
POS
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
PPO
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82010
null
cpt
Ketone bodies analysis quantitative
va
Workers Comp
O
74.94
8.17
8.20
16.29
16.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
EPO
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
HMO
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
Medicaid
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
Medicare Part A
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
Medicare Part B
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
POS
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
PPO
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield
Workers Comp
O
209.24
34.39
34.39
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
EPO
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
HMO
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
Medicaid
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
Medicare Part A
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
Medicare Part B
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
POS
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
PPO
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
blue cross blue shield - medicare advantage
Workers Comp
O
209.24
34.39
55.53
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
EPO
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
HMO
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
Medicaid
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
Medicare Part A
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
Medicare Part B
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
POS
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
PPO
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
humana - medicare advantage
Workers Comp
O
209.24
34.39
38.62
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
EPO
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
HMO
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
Medicaid
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
Medicare Part A
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
Medicare Part B
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
POS
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
PPO
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
tricare
Workers Comp
O
209.24
34.39
38.78
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
EPO
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
HMO
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
Medicaid
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
Medicare Part A
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
Medicare Part B
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
POS
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
PPO
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82024
null
cpt
Adrenocorticotropic hormone (ACTH) level
united healthcare
Workers Comp
O
209.24
34.39
149.46
149.46
125.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
EPO
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
HMO
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
POS
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
PPO
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
12.38
4.97
9.85
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
EPO
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
HMO
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
Medicaid
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
Medicare Part A
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
Medicare Part B
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
POS
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
PPO
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82040
null
cpt
Albumin (protein) level
tricare
Workers Comp
O
12.38
4.97
4.97
9.85
7.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
EPO
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
HMO
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
Medicaid
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
Medicare Part A
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
Medicare Part B
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
POS
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
PPO
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna
Workers Comp
O
63.76
3.47
35.83
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
EPO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
HMO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
Medicaid
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
Medicare Part A
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
Medicare Part B
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
POS
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
PPO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
aetna - medicare advantage
Workers Comp
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
EPO
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
HMO
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
Medicaid
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
Medicare Part A
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
Medicare Part B
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
POS
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
PPO
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield
Workers Comp
O
63.76
3.47
9.95
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
EPO
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
HMO
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
POS
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
PPO
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
63.76
3.47
9.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
EPO
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
HMO
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
Medicaid
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
Medicare Part A
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
Medicare Part B
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
POS
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
PPO
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
cigna
Workers Comp
O
63.76
3.47
45.12
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
EPO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
HMO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
Medicaid
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
Medicare Part A
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
Medicare Part B
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
POS
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
PPO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana
Workers Comp
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
EPO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
HMO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
Medicaid
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
Medicare Part A
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
Medicare Part B
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
POS
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
PPO
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
humana - medicare advantage
Workers Comp
O
63.76
3.47
5.78
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
EPO
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
HMO
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
Medicaid
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
Medicare Part A
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
Medicare Part B
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
POS
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
PPO
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
medica
Workers Comp
O
63.76
3.47
3.47
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
EPO
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
HMO
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
Medicaid
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
Medicare Part A
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
Medicare Part B
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
POS
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
PPO
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
tricare
Workers Comp
O
63.76
3.47
5.80
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
EPO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
HMO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
Medicaid
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
Medicare Part A
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
Medicare Part B
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
POS
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
PPO
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare
Workers Comp
O
63.76
3.47
45.55
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
EPO
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
HMO
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
Medicaid
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
Medicare Part A
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
Medicare Part B
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
POS
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
PPO
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
united healthcare - medicare advantage
Workers Comp
O
63.76
3.47
6.05
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
EPO
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
HMO
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
Medicaid
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
Medicare Part A
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
Medicare Part B
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
POS
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
PPO
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82043
null
cpt
Urine microalbumin (protein) level
va
Workers Comp
O
63.76
3.47
3.87
45.55
6.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
EPO
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
HMO
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
Medicaid
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
Medicare Part A
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
Medicare Part B
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
POS
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
PPO
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield
Workers Comp
O
47.85
4.97
4.97
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
EPO
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
HMO
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
POS
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
PPO
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
47.85
4.97
8.36
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
EPO
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
HMO
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
Medicaid
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
Medicare Part A
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
Medicare Part B
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
POS
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
PPO
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82085
null
cpt
Aldolase (enzyme) level
cigna
Workers Comp
O
47.85
4.97
33.87
33.87
28.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
EPO
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
HMO
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
Medicaid
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
Medicare Part A
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
Medicare Part B
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
POS
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
PPO
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
blue cross blue shield
Workers Comp
O
209.99
34.38
34.38
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
EPO
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
HMO
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
Medicaid
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
Medicare Part A
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
Medicare Part B
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
POS
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
PPO
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
humana - medicare advantage
Workers Comp
O
209.99
34.38
40.75
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
EPO
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
HMO
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
Medicaid
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
Medicare Part A
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
Medicare Part B
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
POS
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
PPO
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82088
null
cpt
Aldosterone hormone level
united healthcare
Workers Comp
O
209.99
34.38
141.51
141.51
125.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
EPO
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
HMO
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
Medicaid
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
Medicare Part A
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
Medicare Part B
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
POS
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
PPO
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield
Workers Comp
O
70.11
7.26
7.26
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
EPO
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
HMO
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
Medicaid
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
Medicare Part A
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
Medicare Part B
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
POS
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
PPO
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
blue cross blue shield - medicare advantage
Workers Comp
O
70.11
7.26
19.41
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
EPO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
HMO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
Medicaid
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
Medicare Part A
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
Medicare Part B
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
POS
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
PPO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
humana - medicare advantage
Workers Comp
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
EPO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
HMO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
Medicaid
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
Medicare Part A
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
Medicare Part B
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
POS
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
PPO
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82103
null
cpt
Alpha-1-antitrypsin (protein) blood test total
va
Workers Comp
O
70.11
7.26
13.44
19.41
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
EPO
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
HMO
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
Medicaid
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
Medicare Part A
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
Medicare Part B
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
POS
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
PPO
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield
Workers Comp
O
140.23
16.77
28.00
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
EPO
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
HMO
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
Medicaid
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
Medicare Part A
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
Medicare Part B
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
POS
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
PPO
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
blue cross blue shield - medicare advantage
Workers Comp
O
140.23
16.77
28.94
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
EPO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
HMO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
Medicaid
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
Medicare Part A
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
Medicare Part B
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
POS
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
PPO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
humana - medicare advantage
Workers Comp
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
EPO
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
HMO
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
Medicaid
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
Medicare Part A
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
Medicare Part B
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
POS
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
PPO
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
tricare
Workers Comp
O
140.23
16.77
16.84
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
EPO
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
HMO
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
Medicaid
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
Medicare Part A
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
Medicare Part B
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
POS
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
PPO
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
united healthcare
Workers Comp
O
140.23
16.77
100.17
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
EPO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
HMO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
Medicaid
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
Medicare Part A
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
Medicare Part B
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
POS
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
PPO
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82105
null
cpt
Alpha-fetoprotein (AFP) level serum
va
Workers Comp
O
140.23
16.77
16.77
100.17
20.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
EPO
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
HMO
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
Medicaid
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
Medicare Part A
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
Medicare Part B
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
POS
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
PPO
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
aetna
Workers Comp
O
102.39
14.57
59.39
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
EPO
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
HMO
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
Medicaid
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
Medicare Part A
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
Medicare Part B
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
POS
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
PPO
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield
Workers Comp
O
102.39
14.57
26.00
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
EPO
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
HMO
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
Medicaid
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
Medicare Part A
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
Medicare Part B
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
POS
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
PPO
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
blue cross blue shield - medicare advantage
Workers Comp
O
102.39
14.57
15.48
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
EPO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
HMO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
Medicaid
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
Medicare Part A
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
Medicare Part B
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
POS
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
PPO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
humana - medicare advantage
Workers Comp
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
EPO
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
HMO
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
Medicaid
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
Medicare Part A
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
Medicare Part B
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
POS
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
PPO
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
tricare
Workers Comp
O
102.39
14.57
14.63
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
EPO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
HMO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
Medicaid
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
Medicare Part A
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
Medicare Part B
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
POS
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
PPO
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82140
null
cpt
Ammonia level
va
Workers Comp
O
102.39
14.57
14.57
59.39
17.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
EPO
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
HMO
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
Medicaid
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
Medicare Part A
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
Medicare Part B
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
POS
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
PPO
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna
Workers Comp
O
47.85
3.91
17.70
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
EPO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
HMO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
Medicaid
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
Medicare Part A
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
Medicare Part B
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
POS
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
PPO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
aetna - medicare advantage
Workers Comp
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
EPO
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
HMO
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
Medicaid
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
Medicare Part A
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
Medicare Part B
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
POS
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
PPO
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield
Workers Comp
O
47.85
3.91
9.61
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
EPO
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
HMO
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
POS
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
PPO
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
47.85
3.91
9.58
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
EPO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
HMO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
Medicaid
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
Medicare Part A
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
Medicare Part B
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
POS
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
PPO
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
humana - medicare advantage
Workers Comp
O
47.85
3.91
6.48
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
EPO
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
HMO
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
Medicaid
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
Medicare Part A
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
Medicare Part B
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
POS
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
PPO
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
tricare
Workers Comp
O
47.85
3.91
6.51
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
EPO
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
HMO
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
Medicaid
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
Medicare Part A
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
Medicare Part B
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
POS
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
PPO
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare
Workers Comp
O
47.85
3.91
34.19
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
EPO
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
HMO
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
Medicaid
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
Medicare Part A
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
Medicare Part B
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
POS
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
PPO
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
united healthcare - medicare advantage
Workers Comp
O
47.85
3.91
6.36
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
EPO
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
HMO
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
Medicaid
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
Medicare Part A
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
Medicare Part B
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
POS
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
PPO
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
va
Workers Comp
O
47.85
3.91
3.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
EPO
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
HMO
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
Medicaid
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
Medicare Part A
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
Medicare Part B
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
POS
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
PPO
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82150
null
cpt
Amylase (enzyme) level
webtpa
Workers Comp
O
47.85
3.91
31.91
34.19
7.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
EPO
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
HMO
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
Medicaid
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
Medicare Part A
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
Medicare Part B
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
POS
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
PPO
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82157
null
cpt
Androstenedione (hormone) level
blue cross blue shield
Workers Comp
O
159.15
26.91
26.91
26.91
95.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
EPO
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
HMO
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
Medicaid
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
Medicare Part A
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
Medicare Part B
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
POS
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
PPO
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield
Workers Comp
O
95.71
13.47
23.62
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
EPO
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
HMO
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
Medicaid
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
POS
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
PPO
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
13.47
13.47
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
EPO
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
HMO
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
Medicaid
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
Medicare Part A
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
Medicare Part B
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
POS
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
PPO
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
humana - medicare advantage
Workers Comp
O
95.71
13.47
14.60
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
EPO
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
HMO
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
Medicaid
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
Medicare Part A
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
Medicare Part B
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
POS
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
PPO
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82164
null
cpt
Angiotensin l - converting enzyme (ACE) level
tricare
Workers Comp
O
95.71
13.47
15.48
23.62
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
EPO
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
HMO
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
Medicaid
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
Medicare Part A
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
Medicare Part B
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
POS
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
PPO
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield
Workers Comp
O
80.13
10.37
10.37
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
EPO
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
HMO
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
Medicaid
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
Medicare Part A
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
Medicare Part B
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
POS
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
PPO
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
blue cross blue shield - medicare advantage
Workers Comp
O
80.13
10.37
10.64
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
EPO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
HMO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
Medicaid
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
Medicare Part A
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
Medicare Part B
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
POS
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
PPO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
humana - medicare advantage
Workers Comp
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
EPO
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
HMO
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
Medicaid
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
Medicare Part A
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
Medicare Part B
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
POS
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
PPO
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
tricare
Workers Comp
O
80.13
10.37
21.18
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
EPO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
HMO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
Medicaid
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
Medicare Part A
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
Medicare Part B
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
POS
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
PPO
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82172
null
cpt
Apolipoprotein level
va
Workers Comp
O
80.13
10.37
21.09
21.18
25.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
EPO
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
HMO
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
Medicaid
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
POS
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
PPO
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82175
null
cpt
Arsenic level
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
13.50
13.50
13.50
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
EPO
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
HMO
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
Medicaid
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
Medicare Part A
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
Medicare Part B
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
POS
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
PPO
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82180
null
cpt
Ascorbic acid (Vitamin C) level blood
blue cross blue shield
Workers Comp
O
104.62
18.18
18.18
18.18
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
EPO
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
HMO
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
Medicaid
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
Medicare Part A
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
Medicare Part B
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
POS
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
PPO
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
822
null
ms-drg
lymphoma and leukemia with major o.r. procedures without cc/mcc
tricare
Workers Comp
I
27248.47
8024.86
8024.86
8024.86
16349.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
EPO
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
HMO
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
Medicaid
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
Medicare Part A
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
Medicare Part B
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
POS
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
PPO
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna
Workers Comp
O
95.71
16.02
16.02
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
EPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
HMO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
Medicaid
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
Medicare Part A
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
Medicare Part B
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
POS
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
PPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
aetna - medicare advantage
Workers Comp
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
EPO
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
HMO
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
Medicaid
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
Medicare Part A
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
Medicare Part B
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
POS
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
PPO
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield
Workers Comp
O
95.71
16.02
17.68
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
EPO
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
HMO
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
POS
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
PPO
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
16.02
33.09
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
EPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
HMO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
Medicaid
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
Medicare Part A
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
Medicare Part B
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
POS
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
PPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
humana - medicare advantage
Workers Comp
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
EPO
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
HMO
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
Medicaid
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
Medicare Part A
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
Medicare Part B
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
POS
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
PPO
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
tricare
Workers Comp
O
95.71
16.02
16.25
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
EPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
HMO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
Medicaid
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
Medicare Part A
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
Medicare Part B
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
POS
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
PPO
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82232
null
cpt
Beta-2 microglobulin (protein) level
va
Workers Comp
O
95.71
16.02
16.18
33.09
19.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
EPO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
HMO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
Medicaid
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
Medicare Part A
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
Medicare Part B
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
POS
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
PPO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
aetna - medicare advantage
Workers Comp
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
EPO
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
HMO
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
Medicaid
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
Medicare Part A
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
Medicare Part B
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
POS
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
PPO
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield
Workers Comp
O
37.10
3.02
3.17
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
EPO
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
HMO
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
Medicaid
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
Medicare Part A
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
Medicare Part B
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
POS
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
PPO
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
blue cross blue shield - medicare advantage
Workers Comp
O
37.10
3.02
3.75
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
EPO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
HMO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
Medicaid
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
Medicare Part A
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
Medicare Part B
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
POS
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
PPO
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
humana - medicare advantage
Workers Comp
O
37.10
3.02
5.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
EPO
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
HMO
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
Medicaid
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
Medicare Part A
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
Medicare Part B
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
POS
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
PPO
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
tricare
Workers Comp
O
37.10
3.02
5.04
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
EPO
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
HMO
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
Medicaid
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
Medicare Part A
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
Medicare Part B
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
POS
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
PPO
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82247
null
cpt
Bilirubin level total
va
Workers Comp
O
37.10
3.02
3.02
5.04
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
EPO
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
HMO
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
Medicaid
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
Medicare Part A
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
Medicare Part B
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
POS
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
PPO
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
aetna
Workers Comp
O
38.95
4.02
23.94
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
EPO
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
HMO
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
Medicaid
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
Medicare Part A
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
Medicare Part B
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
POS
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
PPO
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield
Workers Comp
O
38.95
4.02
6.10
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
EPO
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
HMO
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
Medicaid
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
Medicare Part A
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
Medicare Part B
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
POS
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
PPO
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
blue cross blue shield - medicare advantage
Workers Comp
O
38.95
4.02
6.40
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
EPO
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
HMO
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
Medicaid
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
Medicare Part A
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
Medicare Part B
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
POS
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
PPO
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
humana - medicare advantage
Workers Comp
O
38.95
4.02
5.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
EPO
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
HMO
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
Medicaid
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
Medicare Part A
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
Medicare Part B
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
POS
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
PPO
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
tricare
Workers Comp
O
38.95
4.02
5.04
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
EPO
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
HMO
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
Medicaid
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
Medicare Part A
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
Medicare Part B
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
POS
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
PPO
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
united healthcare
Workers Comp
O
38.95
4.02
27.83
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
EPO
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
HMO
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
Medicaid
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
Medicare Part A
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
Medicare Part B
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
POS
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
PPO
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82248
null
cpt
Bilirubin level direct
va
Workers Comp
O
38.95
4.02
4.02
27.83
6.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
EPO
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
HMO
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
Medicaid
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
Medicare Part A
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
Medicare Part B
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
POS
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
PPO
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield
Workers Comp
O
28.38
2.64
8.54
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
EPO
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
HMO
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
Medicaid
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
Medicare Part A
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
Medicare Part B
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
POS
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
PPO
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
blue cross blue shield - medicare advantage
Workers Comp
O
28.38
2.64
14.63
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
EPO
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
HMO
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
Medicaid
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
Medicare Part A
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
Medicare Part B
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
POS
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
PPO
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
humana - medicare advantage
Workers Comp
O
28.38
2.64
4.38
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
EPO
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
HMO
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
Medicaid
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
Medicare Part A
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
Medicare Part B
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
POS
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
PPO
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
tricare
Workers Comp
O
28.38
2.64
4.40
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
EPO
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
HMO
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
Medicaid
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
Medicare Part A
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
Medicare Part B
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
POS
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
PPO
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
united healthcare
Workers Comp
O
28.38
2.64
20.27
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
EPO
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
HMO
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
Medicaid
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
Medicare Part A
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
Medicare Part B
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
POS
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
PPO
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
va
Workers Comp
O
28.38
2.64
2.64
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
EPO
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
HMO
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
Medicaid
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
Medicare Part A
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
Medicare Part B
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
POS
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
PPO
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82270
null
cpt
Stool analysis for blood to screen for colon tumors
webtpa
Workers Comp
O
28.38
2.64
21.52
21.52
5.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
EPO
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
HMO
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
Medicaid
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
Medicare Part A
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
Medicare Part B
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
POS
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
PPO
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna
Workers Comp
O
95.60
18.82
55.45
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
EPO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
HMO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
Medicaid
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
Medicare Part A
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
Medicare Part B
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
POS
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
PPO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
aetna - medicare advantage
Workers Comp
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
EPO
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
HMO
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
Medicaid
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
Medicare Part A
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
Medicare Part B
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
POS
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
PPO
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield
Workers Comp
O
95.60
18.82
23.42
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
EPO
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
HMO
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
Medicaid
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
Medicare Part A
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
Medicare Part B
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
POS
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
PPO
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
blue cross blue shield - medicare advantage
Workers Comp
O
95.60
18.82
20.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
EPO
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
HMO
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
Medicaid
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
Medicare Part A
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
Medicare Part B
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
POS
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
PPO
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
cigna
Workers Comp
O
95.60
18.82
63.83
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
EPO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
HMO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
Medicaid
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
Medicare Part A
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
Medicare Part B
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
POS
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
PPO
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
humana - medicare advantage
Workers Comp
O
95.60
18.82
29.60
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
EPO
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
HMO
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
Medicaid
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
Medicare Part A
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
Medicare Part B
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
POS
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
PPO
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
medica
Workers Comp
O
95.60
18.82
26.57
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
EPO
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
HMO
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
Medicaid
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
Medicare Part A
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
Medicare Part B
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
POS
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
PPO
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
tricare
Workers Comp
O
95.60
18.82
29.72
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
EPO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
HMO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
Medicaid
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
Medicare Part A
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
Medicare Part B
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
POS
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
PPO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
united healthcare
Workers Comp
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
EPO
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
HMO
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
Medicaid
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
Medicare Part A
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
Medicare Part B
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
POS
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
PPO
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
va
Workers Comp
O
95.60
18.82
18.82
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
EPO
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
HMO
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
Medicaid
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
Medicare Part A
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
Medicare Part B
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
POS
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
PPO
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
webtpa
Workers Comp
O
95.60
18.82
65.33
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
EPO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
HMO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
Medicaid
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
Medicare Part A
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
Medicare Part B
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
POS
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
PPO
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82306
null
cpt
Vitamin D-3 level
worker comp
Workers Comp
O
95.60
18.82
68.29
68.29
35.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
EPO
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
HMO
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
Medicaid
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
Medicare Part A
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
Medicare Part B
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
POS
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
PPO
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield
Workers Comp
O
382.87
41.49
58.71
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
EPO
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
HMO
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
POS
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
PPO
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82308
null
cpt
Calcitonin (hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
382.87
41.49
41.49
58.71
229.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
EPO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
HMO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
Medicaid
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
Medicare Part A
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
Medicare Part B
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
POS
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
PPO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna
Workers Comp
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
EPO
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
HMO
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
Medicaid
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
Medicare Part A
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
Medicare Part B
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
POS
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
PPO
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
aetna - medicare advantage
Workers Comp
O
36.61
5.16
5.62
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
EPO
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
HMO
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
Medicaid
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
Medicare Part A
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
Medicare Part B
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
POS
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
PPO
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield
Workers Comp
O
36.61
5.16
12.28
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
EPO
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
HMO
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
Medicaid
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
Medicare Part A
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
Medicare Part B
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
POS
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
PPO
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
blue cross blue shield - medicare advantage
Workers Comp
O
36.61
5.16
16.47
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
EPO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
HMO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
Medicaid
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
Medicare Part A
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
Medicare Part B
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
POS
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
PPO
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
humana - medicare advantage
Workers Comp
O
36.61
5.16
5.16
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
EPO
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
HMO
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
Medicaid
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
Medicare Part A
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
Medicare Part B
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
POS
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
PPO
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
tricare
Workers Comp
O
36.61
5.16
20.90
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
EPO
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
HMO
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
Medicaid
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
Medicare Part A
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
Medicare Part B
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
POS
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
PPO
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82310
null
cpt
Calcium level total
united healthcare
Workers Comp
O
36.61
5.16
18.36
20.90
21.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
EPO
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
HMO
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
Medicaid
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
Medicare Part A
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
Medicare Part B
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
POS
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
PPO
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield
Workers Comp
O
84.58
13.74
21.39
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
EPO
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
HMO
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
Medicaid
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
Medicare Part A
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
Medicare Part B
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
POS
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
PPO
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
blue cross blue shield - medicare advantage
Workers Comp
O
84.58
13.74
23.36
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
EPO
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
HMO
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
Medicaid
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
Medicare Part A
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
Medicare Part B
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
POS
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
PPO
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82330
null
cpt
Calcium level ionized
tricare
Workers Comp
O
84.58
13.74
13.74
23.36
50.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
EPO
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
HMO
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
Medicaid
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
Medicare Part A
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
Medicare Part B
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
POS
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
PPO
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82340
null
cpt
Urine calcium level
blue cross blue shield - medicare advantage
Workers Comp
O
15.08
5.21
5.21
5.21
9.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
EPO
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
HMO
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
Medicaid
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
Medicare Part A
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
Medicare Part B
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
POS
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
PPO
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield
Workers Comp
O
69.00
12.90
29.06
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
EPO
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
HMO
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
Medicaid
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
Medicare Part A
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
Medicare Part B
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
POS
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
PPO
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
blue cross blue shield - medicare advantage
Workers Comp
O
69.00
12.90
50.50
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
EPO
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
HMO
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
Medicaid
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
Medicare Part A
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
Medicare Part B
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
POS
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
PPO
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
humana - medicare advantage
Workers Comp
O
69.00
12.90
12.90
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
EPO
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
HMO
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
Medicaid
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
Medicare Part A
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
Medicare Part B
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
POS
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
PPO
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
tricare
Workers Comp
O
69.00
12.90
12.95
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
EPO
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
HMO
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
Medicaid
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
Medicare Part A
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
Medicare Part B
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
POS
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
PPO
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82365
null
cpt
Infrared analysis of stone
webtpa
Workers Comp
O
69.00
12.90
48.30
50.50
15.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
EPO
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
HMO
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
Medicaid
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
Medicare Part A
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
Medicare Part B
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
POS
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
PPO
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
aetna
Workers Comp
O
103.50
12.32
60.03
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
EPO
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
HMO
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
Medicaid
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
Medicare Part A
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
Medicare Part B
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
POS
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
PPO
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield
Workers Comp
O
103.50
12.32
20.99
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
EPO
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
HMO
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
POS
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
PPO
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
103.50
12.32
21.34
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
EPO
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
HMO
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
Medicaid
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
Medicare Part A
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
Medicare Part B
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
POS
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
PPO
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
humana - medicare advantage
Workers Comp
O
103.50
12.32
12.32
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
EPO
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
HMO
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
Medicaid
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
Medicare Part A
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
Medicare Part B
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
POS
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
PPO
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82375
null
cpt
Carboxyhemoglobin (protein) level
united healthcare
Workers Comp
O
103.50
12.32
73.94
73.94
14.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
EPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
HMO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
Medicaid
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
Medicare Part A
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
Medicare Part B
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
POS
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
PPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
aetna - medicare advantage
Workers Comp
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
EPO
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
HMO
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
Medicaid
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
Medicare Part A
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
Medicare Part B
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
POS
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
PPO
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield
Workers Comp
O
135.07
18.96
24.53
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
EPO
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
HMO
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
Medicaid
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
Medicare Part A
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
Medicare Part B
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
POS
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
PPO
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
blue cross blue shield - medicare advantage
Workers Comp
O
135.07
18.96
30.58
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
EPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
HMO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
Medicaid
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
Medicare Part A
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
Medicare Part B
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
POS
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
PPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
humana - medicare advantage
Workers Comp
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
EPO
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
HMO
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
Medicaid
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
Medicare Part A
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
Medicare Part B
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
POS
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
PPO
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
tricare
Workers Comp
O
135.07
18.96
19.04
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
EPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
HMO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
Medicaid
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
Medicare Part A
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
Medicare Part B
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
POS
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
PPO
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82378
null
cpt
Carcinoembryonic antigen (CEA) protein level
va
Workers Comp
O
135.07
18.96
18.96
30.58
81.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
EPO
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
HMO
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
Medicaid
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
Medicare Part A
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
Medicare Part B
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
POS
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
PPO
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield
Workers Comp
O
184.75
25.25
34.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
EPO
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
HMO
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
Medicaid
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
Medicare Part A
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
Medicare Part B
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
POS
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
PPO
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
blue cross blue shield - medicare advantage
Workers Comp
O
184.75
25.25
32.93
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
EPO
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
HMO
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
Medicaid
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
Medicare Part A
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
Medicare Part B
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
POS
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
PPO
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
humana - medicare advantage
Workers Comp
O
184.75
25.25
25.25
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
EPO
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
HMO
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
Medicaid
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
Medicare Part A
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
Medicare Part B
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
POS
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
PPO
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82384
null
cpt
Catecholamines (organic nitrogen) level
tricare
Workers Comp
O
184.75
25.25
25.35
34.25
110.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
EPO
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
HMO
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
Medicaid
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
Medicare Part A
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
Medicare Part B
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
POS
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
PPO
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
aetna
Workers Comp
O
67.89
7.03
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
EPO
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
HMO
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
Medicaid
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
Medicare Part A
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
Medicare Part B
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
POS
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
PPO
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield
Workers Comp
O
67.89
7.03
7.03
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
EPO
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
HMO
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
POS
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
PPO
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
7.03
19.33
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
EPO
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
HMO
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
Medicaid
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
Medicare Part A
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
Medicare Part B
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
POS
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
PPO
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
tricare
Workers Comp
O
67.89
7.03
11.98
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
EPO
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
HMO
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
Medicaid
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
Medicare Part A
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
Medicare Part B
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
POS
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
PPO
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82390
null
cpt
Ceruloplasmin (protein) level
va
Workers Comp
O
67.89
7.03
10.74
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
EPO
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
HMO
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
Medicaid
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
Medicare Part A
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
Medicare Part B
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
POS
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
PPO
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield
Workers Comp
O
48.49
6.48
6.48
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
EPO
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
HMO
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
Medicaid
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
Medicare Part A
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
Medicare Part B
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
POS
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
PPO
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
blue cross blue shield - medicare advantage
Workers Comp
O
48.49
6.48
6.61
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
EPO
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
HMO
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
Medicaid
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
Medicare Part A
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
Medicare Part B
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
POS
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
PPO
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82397
null
cpt
Analysis using chemiluminescent technique (light and chemical )reaction
tricare
Workers Comp
O
48.49
6.48
14.18
14.18
29.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
EPO
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
HMO
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
Medicaid
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
Medicare Part A
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
Medicare Part B
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
POS
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
PPO
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
824
null
ms-drg
lymphoma and non-acute leukemia with other procedures with cc
humana - medicare advantage
Workers Comp
I
55689.66
14124.56
14124.56
14124.56
33413.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
EPO
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
HMO
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
Medicaid
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
Medicare Part A
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
Medicare Part B
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
POS
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
PPO
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82435
null
cpt
Blood chloride level
va
Workers Comp
O
24.38
3.08
3.08
3.08
14.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
EPO
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
HMO
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
Medicaid
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
Medicare Part A
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
Medicare Part B
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
POS
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
PPO
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82465
null
cpt
Cholesterol level
humana - medicare advantage
Workers Comp
O
35.38
4.35
4.35
4.35
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
EPO
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
HMO
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
Medicaid
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
Medicare Part A
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
Medicare Part B
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
POS
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
PPO
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
aetna
Workers Comp
O
67.89
12.19
39.38
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
EPO
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
HMO
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
Medicaid
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
Medicare Part A
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
Medicare Part B
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
POS
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
PPO
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield
Workers Comp
O
67.89
12.19
12.19
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
EPO
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
HMO
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
Medicaid
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
POS
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
PPO
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
12.19
17.85
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
EPO
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
HMO
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
Medicaid
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
Medicare Part A
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
Medicare Part B
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
POS
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
PPO
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
humana - medicare advantage
Workers Comp
O
67.89
12.19
12.41
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
EPO
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
HMO
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
Medicaid
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
Medicare Part A
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
Medicare Part B
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
POS
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
PPO
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82525
null
cpt
Copper level
tricare
Workers Comp
O
67.89
12.19
12.46
39.38
14.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
EPO
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
HMO
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
Medicaid
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
Medicare Part A
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
Medicare Part B
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
POS
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
PPO
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
blue cross blue shield
Workers Comp
O
169.49
16.71
35.81
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
EPO
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
HMO
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
Medicaid
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
Medicare Part A
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
Medicare Part B
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
POS
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
PPO
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
humana - medicare advantage
Workers Comp
O
169.49
16.71
16.71
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
EPO
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
HMO
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
Medicaid
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
Medicare Part A
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
Medicare Part B
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
POS
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
PPO
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82530
null
cpt
Cortisol (hormone) measurement free
tricare
Workers Comp
O
169.49
16.71
16.78
35.81
101.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
EPO
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
HMO
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
Medicaid
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
Medicare Part A
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
Medicare Part B
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
POS
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
PPO
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield
Workers Comp
O
105.73
10.37
18.38
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
EPO
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
HMO
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
Medicaid
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
Medicare Part A
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
Medicare Part B
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
POS
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
PPO
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
blue cross blue shield - medicare advantage
Workers Comp
O
105.73
10.37
25.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
EPO
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
HMO
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
Medicaid
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
Medicare Part A
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
Medicare Part B
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
POS
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
PPO
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
humana - medicare advantage
Workers Comp
O
105.73
10.37
16.30
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
EPO
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
HMO
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
Medicaid
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
Medicare Part A
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
Medicare Part B
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
POS
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
PPO
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
tricare
Workers Comp
O
105.73
10.37
16.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
EPO
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
HMO
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
Medicaid
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
Medicare Part A
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
Medicare Part B
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
POS
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
PPO
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82533
null
cpt
Cortisol (hormone) measurement total
va
Workers Comp
O
105.73
10.37
10.37
25.30
19.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
EPO
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
HMO
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
Medicaid
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
Medicare Part A
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
Medicare Part B
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
POS
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
PPO
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield
Workers Comp
O
87.98
13.84
13.84
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
EPO
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
HMO
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
Medicaid
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
Medicare Part A
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
Medicare Part B
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
POS
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
PPO
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
blue cross blue shield - medicare advantage
Workers Comp
O
87.98
13.84
21.54
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
EPO
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
HMO
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
Medicaid
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
Medicare Part A
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
Medicare Part B
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
POS
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
PPO
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
humana - medicare advantage
Workers Comp
O
87.98
13.84
24.09
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
EPO
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
HMO
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
Medicaid
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
Medicare Part A
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
Medicare Part B
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
POS
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
PPO
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82542
null
cpt
Chemical analysis using chromatography technique
tricare
Workers Comp
O
87.98
13.84
24.19
24.19
52.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
EPO
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
HMO
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
Medicaid
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
Medicare Part A
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
Medicare Part B
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
POS
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
PPO
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
aetna
Workers Comp
O
56.76
6.51
32.92
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
EPO
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
HMO
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
Medicaid
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
Medicare Part A
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
Medicare Part B
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
POS
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
PPO
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield
Workers Comp
O
56.76
6.51
10.82
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
EPO
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
HMO
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
Medicaid
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
Medicare Part A
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
Medicare Part B
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
POS
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
PPO
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
blue cross blue shield - medicare advantage
Workers Comp
O
56.76
6.51
8.64
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
EPO
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
HMO
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
Medicaid
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
Medicare Part A
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
Medicare Part B
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
POS
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
PPO
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
humana - medicare advantage
Workers Comp
O
56.76
6.51
6.51
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
EPO
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
HMO
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
Medicaid
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
Medicare Part A
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
Medicare Part B
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
POS
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
PPO
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
tricare
Workers Comp
O
56.76
6.51
6.54
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
EPO
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
HMO
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
Medicaid
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
Medicare Part A
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
Medicare Part B
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
POS
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
PPO
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82550
null
cpt
Creatine kinase (cardiac enzyme) level total
united healthcare
Workers Comp
O
56.76
6.51
89.14
89.14
7.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
EPO
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
HMO
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
Medicaid
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
Medicare Part A
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
Medicare Part B
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
POS
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
PPO
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield
Workers Comp
O
42.51
9.61
9.61
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
EPO
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
HMO
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
Medicaid
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
Medicare Part A
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
Medicare Part B
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
POS
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
PPO
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
blue cross blue shield - medicare advantage
Workers Comp
O
42.51
9.61
10.58
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
EPO
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
HMO
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
Medicaid
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
Medicare Part A
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
Medicare Part B
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
POS
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
PPO
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
humana - medicare advantage
Workers Comp
O
42.51
9.61
11.55
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
EPO
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
HMO
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
Medicaid
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
Medicare Part A
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
Medicare Part B
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
POS
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
PPO
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82553
null
cpt
Creatine kinase (cardiac enzyme) level MB fraction only
united healthcare
Workers Comp
O
42.51
9.61
129.21
129.21
13.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
EPO
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
HMO
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
Medicaid
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
Medicare Part A
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
Medicare Part B
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
POS
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
PPO
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna
Workers Comp
O
36.04
3.26
17.15
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
EPO
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
HMO
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
Medicaid
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
Medicare Part A
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
Medicare Part B
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
POS
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
PPO
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
aetna - medicare advantage
Workers Comp
O
36.04
3.26
5.35
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
EPO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
HMO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
Medicaid
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
Medicare Part A
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
Medicare Part B
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
POS
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
PPO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield
Workers Comp
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
EPO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
HMO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
Medicaid
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
Medicare Part A
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
Medicare Part B
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
POS
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
PPO
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
blue cross blue shield - medicare advantage
Workers Comp
O
36.04
3.26
7.77
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
EPO
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
HMO
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
Medicaid
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
Medicare Part A
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
Medicare Part B
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
POS
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
PPO
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
cigna
Workers Comp
O
36.04
3.26
25.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
EPO
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
HMO
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
Medicaid
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
Medicare Part A
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
Medicare Part B
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
POS
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
PPO
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
humana - medicare advantage
Workers Comp
O
36.04
3.26
5.12
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
EPO
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
HMO
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
Medicaid
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
Medicare Part A
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
Medicare Part B
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
POS
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
PPO
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
tricare
Workers Comp
O
36.04
3.26
5.43
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
EPO
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
HMO
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
Medicaid
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
Medicare Part A
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
Medicare Part B
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
POS
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
PPO
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
united healthcare
Workers Comp
O
36.04
3.26
27.03
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
EPO
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
HMO
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
Medicaid
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
Medicare Part A
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
Medicare Part B
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
POS
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
PPO
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
va
Workers Comp
O
36.04
3.26
3.26
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
EPO
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
HMO
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
Medicaid
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
Medicare Part A
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
Medicare Part B
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
POS
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
PPO
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82565
null
cpt
Blood creatinine level
worker comp
Workers Comp
O
36.04
3.26
20.27
27.03
6.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
EPO
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
HMO
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
Medicaid
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
Medicare Part A
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
Medicare Part B
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
POS
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
PPO
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna
Workers Comp
O
47.18
4.32
27.36
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
EPO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
HMO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
Medicaid
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
Medicare Part A
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
Medicare Part B
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
POS
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
PPO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
aetna - medicare advantage
Workers Comp
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
EPO
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
HMO
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
Medicaid
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
Medicare Part A
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
Medicare Part B
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
POS
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
PPO
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield
Workers Comp
O
47.18
4.32
8.45
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
EPO
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
HMO
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
Medicaid
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
Medicare Part A
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
Medicare Part B
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
POS
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
PPO
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
blue cross blue shield - medicare advantage
Workers Comp
O
47.18
4.32
8.07
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
EPO
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
HMO
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
Medicaid
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
Medicare Part A
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
Medicare Part B
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
POS
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
PPO
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
cigna
Workers Comp
O
47.18
4.32
33.39
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
EPO
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
HMO
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
Medicaid
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
Medicare Part A
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
Medicare Part B
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
POS
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
PPO
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
healthchoice
Workers Comp
O
47.18
4.32
74.53
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
EPO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
HMO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
Medicaid
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
Medicare Part A
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
Medicare Part B
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
POS
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
PPO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana
Workers Comp
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
EPO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
HMO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
Medicaid
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
Medicare Part A
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
Medicare Part B
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
POS
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
PPO
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
humana - medicare advantage
Workers Comp
O
47.18
4.32
5.18
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
EPO
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
HMO
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
Medicaid
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
Medicare Part A
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
Medicare Part B
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
POS
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
PPO
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
medica
Workers Comp
O
47.18
4.32
10.29
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
EPO
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
HMO
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
Medicaid
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
Medicare Part A
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
Medicare Part B
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
POS
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
PPO
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
tricare
Workers Comp
O
47.18
4.32
5.20
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
EPO
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
HMO
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
Medicaid
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
Medicare Part A
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
Medicare Part B
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
POS
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
PPO
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare
Workers Comp
O
47.18
4.32
53.51
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
EPO
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
HMO
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
Medicaid
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
Medicare Part A
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
Medicare Part B
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
POS
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
PPO
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
united healthcare - medicare advantage
Workers Comp
O
47.18
4.32
5.65
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
EPO
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
HMO
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
Medicaid
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
Medicare Part A
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
Medicare Part B
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
POS
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
PPO
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
va
Workers Comp
O
47.18
4.32
4.32
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
EPO
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
HMO
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
Medicaid
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
Medicare Part A
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
Medicare Part B
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
POS
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
PPO
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
webtpa
Workers Comp
O
47.18
4.32
40.75
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
EPO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
HMO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
Medicaid
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
Medicare Part A
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
Medicare Part B
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
POS
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
PPO
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82570
null
cpt
Creatinine level to test for kidney function or muscle injury
worker comp
Workers Comp
O
47.18
4.32
33.71
74.53
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
EPO
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
HMO
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
Medicaid
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
Medicare Part A
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
Medicare Part B
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
POS
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
PPO
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
aetna
Workers Comp
O
132.44
9.46
44.65
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
EPO
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
HMO
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
Medicaid
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
Medicare Part A
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
Medicare Part B
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
POS
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
PPO
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
blue cross blue shield
Workers Comp
O
132.44
9.46
14.49
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
EPO
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
HMO
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
Medicaid
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
Medicare Part A
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
Medicare Part B
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
POS
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
PPO
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
humana - medicare advantage
Workers Comp
O
132.44
9.46
9.46
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
EPO
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
HMO
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
Medicaid
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
Medicare Part A
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
Medicare Part B
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
POS
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
PPO
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
tricare
Workers Comp
O
132.44
9.46
9.50
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
EPO
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
HMO
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
Medicaid
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
Medicare Part A
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
Medicare Part B
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
POS
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
PPO
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82575
null
cpt
Creatinine clearance measurement to test for kidney function
united healthcare
Workers Comp
O
132.44
9.46
54.06
54.06
11.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
EPO
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
HMO
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
Medicaid
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
Medicare Part A
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
Medicare Part B
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
POS
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
PPO
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82595
null
cpt
Cryoglobulin (protein) measurement
blue cross blue shield
Workers Comp
O
37.84
6.99
6.99
6.99
22.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
EPO
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
HMO
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
Medicaid
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
Medicare Part A
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
Medicare Part B
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
POS
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
PPO
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna
Workers Comp
O
69.66
10.09
40.40
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
EPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
HMO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
Medicaid
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
Medicare Part A
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
Medicare Part B
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
POS
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
PPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
aetna - medicare advantage
Workers Comp
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
EPO
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
HMO
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
Medicaid
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
Medicare Part A
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
Medicare Part B
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
POS
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
PPO
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield
Workers Comp
O
69.66
10.09
15.20
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
EPO
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
HMO
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
Medicaid
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
Medicare Part A
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
Medicare Part B
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
POS
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
PPO
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
blue cross blue shield - medicare advantage
Workers Comp
O
69.66
10.09
13.81
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
EPO
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
HMO
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
Medicaid
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
Medicare Part A
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
Medicare Part B
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
POS
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
PPO
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
cigna
Workers Comp
O
69.66
10.09
49.30
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
EPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
HMO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
Medicaid
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
Medicare Part A
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
Medicare Part B
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
POS
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
PPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
humana - medicare advantage
Workers Comp
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
EPO
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
HMO
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
Medicaid
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
Medicare Part A
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
Medicare Part B
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
POS
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
PPO
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
medica
Workers Comp
O
69.66
10.09
17.41
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
EPO
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
HMO
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
Medicaid
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
Medicare Part A
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
Medicare Part B
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
POS
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
PPO
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
tricare
Workers Comp
O
69.66
10.09
15.14
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
EPO
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
HMO
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
Medicaid
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
Medicare Part A
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
Medicare Part B
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
POS
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
PPO
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare
Workers Comp
O
69.66
10.09
49.76
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
EPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
HMO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
Medicaid
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
Medicare Part A
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
Medicare Part B
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
POS
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
PPO
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
united healthcare - medicare advantage
Workers Comp
O
69.66
10.09
15.08
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
EPO
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
HMO
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
Medicaid
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
Medicare Part A
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
Medicare Part B
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
POS
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
PPO
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
va
Workers Comp
O
69.66
10.09
10.09
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
EPO
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
HMO
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
Medicaid
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
Medicare Part A
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
Medicare Part B
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
POS
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
PPO
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82607
null
cpt
Cyanocobalamin (vitamin B-12) level
webtpa
Workers Comp
O
69.66
10.09
46.45
49.76
18.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
EPO
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
HMO
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
Medicaid
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
Medicare Part A
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
Medicare Part B
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
POS
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
PPO
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
aetna
Workers Comp
O
148.02
24.20
85.85
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
EPO
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
HMO
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
Medicaid
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
Medicare Part A
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
Medicare Part B
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
POS
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
PPO
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield
Workers Comp
O
148.02
24.20
26.70
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
EPO
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
HMO
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
Medicaid
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
Medicare Part A
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
Medicare Part B
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
POS
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
PPO
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
blue cross blue shield - medicare advantage
Workers Comp
O
148.02
24.20
24.20
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
EPO
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
HMO
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
Medicaid
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
Medicare Part A
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
Medicare Part B
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
POS
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
PPO
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
united healthcare
Workers Comp
O
148.02
24.20
105.74
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
EPO
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
HMO
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
Medicaid
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
Medicare Part A
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
Medicare Part B
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
POS
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
PPO
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82626
null
cpt
Dehydroepiandrosterone (DHEA) hormone level
va
Workers Comp
O
148.02
24.20
25.27
105.74
88.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
EPO
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
HMO
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
Medicaid
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
Medicare Part A
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
Medicare Part B
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
POS
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
PPO
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield
Workers Comp
O
112.41
15.33
21.14
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
EPO
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
HMO
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
Medicaid
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
Medicare Part A
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
Medicare Part B
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
POS
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
PPO
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
blue cross blue shield - medicare advantage
Workers Comp
O
112.41
15.33
15.33
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
EPO
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
HMO
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
Medicaid
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
Medicare Part A
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
Medicare Part B
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
POS
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
PPO
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
tricare
Workers Comp
O
112.41
15.33
22.32
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
EPO
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
HMO
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
Medicaid
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
Medicare Part A
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
Medicare Part B
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
POS
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
PPO
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82627
null
cpt
Dehydroepiandrosterone (DHEA-S) hormone level
united healthcare
Workers Comp
O
112.41
15.33
80.30
80.30
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
EPO
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
HMO
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
Medicaid
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
Medicare Part A
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
Medicare Part B
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
POS
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
PPO
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield
Workers Comp
O
209.24
37.73
44.36
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
EPO
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
HMO
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
Medicaid
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
Medicare Part A
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
Medicare Part B
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
POS
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
PPO
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
blue cross blue shield - medicare advantage
Workers Comp
O
209.24
37.73
45.84
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
EPO
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
HMO
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
Medicaid
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
Medicare Part A
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
Medicare Part B
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
POS
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
PPO
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
humana - medicare advantage
Workers Comp
O
209.24
37.73
37.73
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
EPO
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
HMO
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
Medicaid
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
Medicare Part A
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
Medicare Part B
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
POS
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
PPO
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82652
null
cpt
Dihydroxyvitamin D 1 25 level
tricare
Workers Comp
O
209.24
37.73
38.66
45.84
46.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
EPO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
HMO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
Medicaid
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
Medicare Part A
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
Medicare Part B
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
POS
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
PPO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
aetna - medicare advantage
Workers Comp
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
EPO
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
HMO
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
Medicaid
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
Medicare Part A
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
Medicare Part B
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
POS
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
PPO
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield
Workers Comp
O
222.99
9.63
74.18
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
EPO
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
HMO
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
Medicaid
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
POS
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
PPO
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
222.99
9.63
28.00
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
EPO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
HMO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
Medicaid
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
Medicare Part A
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
Medicare Part B
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
POS
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
PPO
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
humana - medicare advantage
Workers Comp
O
222.99
9.63
11.53
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
EPO
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
HMO
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
Medicaid
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
Medicare Part A
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
Medicare Part B
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
POS
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
PPO
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
tricare
Workers Comp
O
222.99
9.63
12.22
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
EPO
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
HMO
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
Medicaid
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
Medicare Part A
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
Medicare Part B
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
POS
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
PPO
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
united healthcare
Workers Comp
O
222.99
9.63
159.29
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
EPO
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
HMO
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
Medicaid
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
Medicare Part A
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
Medicare Part B
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
POS
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
PPO
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82656
null
cpt
Pancreatic elastase (enzyme) measurement
va
Workers Comp
O
222.99
9.63
9.63
159.29
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
EPO
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
HMO
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
Medicaid
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
Medicare Part A
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
Medicare Part B
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
POS
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
PPO
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna
Workers Comp
O
140.23
18.61
50.06
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
EPO
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
HMO
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
Medicaid
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
Medicare Part A
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
Medicare Part B
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
POS
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
PPO
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
aetna - medicare advantage
Workers Comp
O
140.23
18.61
18.61
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
EPO
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
HMO
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
Medicaid
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
Medicare Part A
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
Medicare Part B
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
POS
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
PPO
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield
Workers Comp
O
140.23
18.61
22.91
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
EPO
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
HMO
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
POS
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
PPO
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
140.23
18.61
23.26
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
EPO
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
HMO
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
Medicaid
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
Medicare Part A
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
Medicare Part B
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
POS
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
PPO
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
humana - medicare advantage
Workers Comp
O
140.23
18.61
18.79
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
EPO
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
HMO
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
Medicaid
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
Medicare Part A
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
Medicare Part B
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
POS
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
PPO
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
tricare
Workers Comp
O
140.23
18.61
18.87
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
EPO
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
HMO
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
Medicaid
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
Medicare Part A
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
Medicare Part B
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
POS
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
PPO
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82668
null
cpt
Erythropoietin (protein) level
webtpa
Workers Comp
O
140.23
18.61
93.49
93.49
22.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
EPO
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
HMO
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
Medicaid
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
Medicare Part A
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
Medicare Part B
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
POS
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
PPO
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
aetna
Workers Comp
O
156.93
22.39
91.02
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
EPO
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
HMO
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
Medicaid
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
Medicare Part A
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
Medicare Part B
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
POS
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
PPO
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield
Workers Comp
O
156.93
22.39
32.28
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
EPO
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
HMO
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
POS
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
PPO
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
156.93
22.39
30.45
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
EPO
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
HMO
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
Medicaid
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
Medicare Part A
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
Medicare Part B
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
POS
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
PPO
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
humana - medicare advantage
Workers Comp
O
156.93
22.39
27.94
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
EPO
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
HMO
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
Medicaid
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
Medicare Part A
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
Medicare Part B
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
POS
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
PPO
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
tricare
Workers Comp
O
156.93
22.39
28.05
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
EPO
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
HMO
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
Medicaid
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
Medicare Part A
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
Medicare Part B
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
POS
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
PPO
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
united healthcare
Workers Comp
O
156.93
22.39
112.10
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
EPO
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
HMO
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
Medicaid
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
Medicare Part A
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
Medicare Part B
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
POS
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
PPO
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
va
Workers Comp
O
156.93
22.39
22.39
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
EPO
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
HMO
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
Medicaid
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
Medicare Part A
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
Medicare Part B
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
POS
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
PPO
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82670
null
cpt
Estradiol (hormone) level
webtpa
Workers Comp
O
156.93
22.39
104.62
112.10
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
EPO
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
HMO
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
Medicaid
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
Medicare Part A
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
Medicare Part B
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
POS
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
PPO
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield
Workers Comp
O
411.81
32.30
63.16
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
EPO
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
HMO
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
Medicaid
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
Medicare Part A
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
Medicare Part B
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
POS
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
PPO
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
blue cross blue shield - medicare advantage
Workers Comp
O
411.81
32.30
67.51
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
EPO
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
HMO
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
Medicaid
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
Medicare Part A
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
Medicare Part B
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
POS
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
PPO
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
humana - medicare advantage
Workers Comp
O
411.81
32.30
32.30
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
EPO
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
HMO
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
Medicaid
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
Medicare Part A
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
Medicare Part B
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
POS
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
PPO
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82671
null
cpt
Estrogen analysis fractionated
webtpa
Workers Comp
O
411.81
32.30
274.54
274.54
247.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
EPO
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
HMO
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
Medicaid
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
POS
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
PPO
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82693
null
cpt
Ethylene glycol (antifreeze) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
291.50
27.57
27.57
27.57
174.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
EPO
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
HMO
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
Medicaid
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
Medicare Part A
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
Medicare Part B
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
POS
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
PPO
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82705
null
cpt
Stool fat or lipids analysis qualitative
humana - medicare advantage
Workers Comp
O
12.75
5.10
5.10
5.10
7.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
EPO
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
HMO
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
Medicaid
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
Medicare Part A
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
Medicare Part B
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
POS
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
PPO
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna
Workers Comp
O
80.13
13.07
46.48
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
EPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
HMO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
Medicaid
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
Medicare Part A
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
Medicare Part B
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
POS
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
PPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
aetna - medicare advantage
Workers Comp
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
EPO
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
HMO
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
Medicaid
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
Medicare Part A
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
Medicare Part B
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
POS
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
PPO
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield
Workers Comp
O
80.13
13.07
13.44
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
EPO
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
HMO
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
Medicaid
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
POS
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
PPO
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
80.13
13.07
13.07
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
EPO
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
HMO
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
Medicaid
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
Medicare Part A
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
Medicare Part B
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
POS
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
PPO
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
cigna
Workers Comp
O
80.13
13.07
53.50
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
EPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
HMO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
Medicaid
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
Medicare Part A
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
Medicare Part B
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
POS
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
PPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
humana - medicare advantage
Workers Comp
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
EPO
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
HMO
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
Medicaid
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
Medicare Part A
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
Medicare Part B
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
POS
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
PPO
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
tricare
Workers Comp
O
80.13
13.07
13.69
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
EPO
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
HMO
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
Medicaid
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
Medicare Part A
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
Medicare Part B
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
POS
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
PPO
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
united healthcare
Workers Comp
O
80.13
13.07
57.24
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
EPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
HMO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
Medicaid
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
Medicare Part A
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
Medicare Part B
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
POS
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
PPO
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
va
Workers Comp
O
80.13
13.07
13.63
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
EPO
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
HMO
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
Medicaid
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
Medicare Part A
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
Medicare Part B
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
POS
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
PPO
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82728
null
cpt
Ferritin (blood protein) level
webtpa
Workers Comp
O
80.13
13.07
53.42
57.24
16.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
EPO
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
HMO
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
Medicaid
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
Medicare Part A
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
Medicare Part B
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
POS
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
PPO
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield
Workers Comp
O
533.34
63.41
83.17
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
EPO
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
HMO
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
Medicaid
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
Medicare Part A
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
Medicare Part B
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
POS
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
PPO
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
blue cross blue shield - medicare advantage
Workers Comp
O
533.34
63.41
63.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
EPO
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
HMO
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
Medicaid
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
Medicare Part A
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
Medicare Part B
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
POS
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
PPO
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
cigna
Workers Comp
O
533.34
63.41
356.07
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
EPO
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
HMO
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
Medicaid
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
Medicare Part A
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
Medicare Part B
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
POS
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
PPO
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
tricare
Workers Comp
O
533.34
63.41
119.48
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
EPO
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
HMO
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
Medicaid
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
Medicare Part A
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
Medicare Part B
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
POS
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
PPO
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82731
null
cpt
Fetal fibronectin (protein) analysis
va
Workers Comp
O
533.34
63.41
64.41
356.07
115.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
EPO
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
HMO
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
Medicaid
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
Medicare Part A
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
Medicare Part B
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
POS
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
PPO
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna
Workers Comp
O
61.43
9.85
35.63
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
EPO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
HMO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
Medicaid
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
Medicare Part A
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
Medicare Part B
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
POS
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
PPO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
aetna - medicare advantage
Workers Comp
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
EPO
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
HMO
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
Medicaid
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
Medicare Part A
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
Medicare Part B
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
POS
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
PPO
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield
Workers Comp
O
61.43
9.85
12.02
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
EPO
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
HMO
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
Medicaid
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
Medicare Part A
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
Medicare Part B
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
POS
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
PPO
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
blue cross blue shield - medicare advantage
Workers Comp
O
61.43
9.85
12.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
EPO
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
HMO
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
Medicaid
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
Medicare Part A
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
Medicare Part B
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
POS
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
PPO
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
cigna
Workers Comp
O
61.43
9.85
43.47
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
EPO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
HMO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
Medicaid
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
Medicare Part A
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
Medicare Part B
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
POS
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
PPO
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
humana - medicare advantage
Workers Comp
O
61.43
9.85
14.70
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
EPO
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
HMO
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
Medicaid
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
Medicare Part A
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
Medicare Part B
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
POS
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
PPO
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
tricare
Workers Comp
O
61.43
9.85
14.76
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
EPO
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
HMO
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
Medicaid
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
Medicare Part A
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
Medicare Part B
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
POS
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
PPO
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
united healthcare
Workers Comp
O
61.43
9.85
43.88
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
EPO
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
HMO
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
Medicaid
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
Medicare Part A
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
Medicare Part B
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
POS
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
PPO
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82746
null
cpt
Folic acid level serum
va
Workers Comp
O
61.43
9.85
9.85
43.88
17.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
EPO
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
HMO
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
Medicaid
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
Medicare Part A
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
Medicare Part B
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
POS
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
PPO
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield
Workers Comp
O
84.80
15.55
25.69
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
EPO
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
HMO
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
Medicaid
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
Medicare Part A
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
Medicare Part B
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
POS
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
PPO
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
blue cross blue shield - medicare advantage
Workers Comp
O
84.80
15.55
15.55
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
EPO
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
HMO
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
Medicaid
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
Medicare Part A
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
Medicare Part B
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
POS
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
PPO
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82747
null
cpt
Folic acid level RBC
humana - medicare advantage
Workers Comp
O
84.80
15.55
18.94
25.69
50.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
EPO
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
HMO
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
Medicaid
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
Medicare Part A
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
Medicare Part B
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
POS
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
PPO
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna
Workers Comp
O
65.66
9.30
23.10
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
EPO
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
HMO
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
Medicaid
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
Medicare Part A
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
Medicare Part B
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
POS
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
PPO
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
aetna - medicare advantage
Workers Comp
O
65.66
9.30
27.90
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
EPO
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
HMO
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
Medicaid
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
Medicare Part A
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
Medicare Part B
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
POS
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
PPO
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield
Workers Comp
O
65.66
9.30
13.89
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
EPO
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
HMO
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
Medicaid
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
POS
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
PPO
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
65.66
9.30
12.83
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
EPO
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
HMO
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
Medicaid
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
Medicare Part A
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
Medicare Part B
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
POS
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
PPO
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
cigna
Workers Comp
O
65.66
9.30
46.47
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
EPO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
HMO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
Medicaid
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
Medicare Part A
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
Medicare Part B
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
POS
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
PPO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
humana - medicare advantage
Workers Comp
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
EPO
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
HMO
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
Medicaid
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
Medicare Part A
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
Medicare Part B
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
POS
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
PPO
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
tricare
Workers Comp
O
65.66
9.30
9.34
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
EPO
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
HMO
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
Medicaid
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
Medicare Part A
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
Medicare Part B
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
POS
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
PPO
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
united healthcare
Workers Comp
O
65.66
9.30
48.08
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
EPO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
HMO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
Medicaid
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
Medicare Part A
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
Medicare Part B
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
POS
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
PPO
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82784
null
cpt
Gammaglobulin (immune system protein) measurement
va
Workers Comp
O
65.66
9.30
9.30
48.08
11.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
EPO
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
HMO
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
Medicaid
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
Medicare Part A
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
Medicare Part B
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
POS
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
PPO
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
aetna
Workers Comp
O
65.66
7.38
36.90
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
EPO
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
HMO
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
Medicaid
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
Medicare Part A
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
Medicare Part B
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
POS
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
PPO
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield
Workers Comp
O
65.66
7.38
11.11
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
EPO
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
HMO
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
Medicaid
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
POS
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
PPO
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
65.66
7.38
7.38
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
EPO
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
HMO
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
Medicaid
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
Medicare Part A
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
Medicare Part B
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
POS
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
PPO
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
humana - medicare advantage
Workers Comp
O
65.66
7.38
16.46
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
EPO
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
HMO
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
Medicaid
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
Medicare Part A
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
Medicare Part B
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
POS
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
PPO
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82785
null
cpt
IgE (immune system protein) level
tricare
Workers Comp
O
65.66
7.38
16.53
36.90
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
EPO
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
HMO
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
Medicaid
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
Medicare Part A
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
Medicare Part B
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
POS
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
PPO
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82787
null
cpt
Gammaglobulin (immune system protein) measurement immunoglobulin subclasses
blue cross blue shield
Workers Comp
O
50.13
8.38
8.38
8.38
30.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
EPO
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
HMO
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
Medicaid
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
Medicare Part A
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
Medicare Part B
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
POS
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
PPO
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
aetna
Workers Comp
O
149.14
26.18
86.50
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
EPO
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
HMO
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
Medicaid
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
Medicare Part A
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
Medicare Part B
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
POS
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
PPO
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield
Workers Comp
O
149.14
26.18
30.25
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
EPO
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
HMO
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
Medicaid
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
POS
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
PPO
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
blue cross blue shield - medicare advantage
Workers Comp
O
149.14
26.18
30.75
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
EPO
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
HMO
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
Medicaid
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
Medicare Part A
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
Medicare Part B
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
POS
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
PPO
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
united healthcare
Workers Comp
O
149.14
26.18
106.53
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
EPO
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
HMO
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
Medicaid
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
Medicare Part A
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
Medicare Part B
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
POS
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
PPO
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82803
null
cpt
Blood gases measurement
va
Workers Comp
O
149.14
26.18
26.18
106.53
31.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
EPO
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
HMO
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
Medicaid
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
Medicare Part A
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
Medicare Part B
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
POS
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
PPO
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82805
null
cpt
Blood gases measurement with O2 saturation
blue cross blue shield
Workers Comp
O
69.00
9.98
9.98
9.98
41.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
EPO
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
HMO
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
Medicaid
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
Medicare Part A
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
Medicare Part B
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
POS
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
PPO
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
blue cross blue shield
Workers Comp
O
112.41
17.63
31.92
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
EPO
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
HMO
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
Medicaid
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
Medicare Part A
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
Medicare Part B
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
POS
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
PPO
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82941
null
cpt
Gastrin (GI tract hormone) level
humana - medicare advantage
Workers Comp
O
112.41
17.63
17.63
31.92
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
EPO
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
HMO
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
Medicaid
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
Medicare Part A
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
Medicare Part B
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
POS
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
PPO
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82943
null
cpt
Glucagon (pancreatic hormone) level
blue cross blue shield
Workers Comp
O
35.73
10.19
10.19
10.19
21.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
EPO
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
HMO
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
Medicaid
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
Medicare Part A
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
Medicare Part B
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
POS
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
PPO
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82945
null
cpt
Glucose (sugar) level on body fluid
humana - medicare advantage
Workers Comp
O
33.46
3.93
3.93
3.93
20.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
EPO
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
HMO
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
Medicaid
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
Medicare Part A
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
Medicare Part B
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
POS
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
PPO
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield
Workers Comp
O
34.27
2.63
7.28
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
EPO
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
HMO
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
Medicaid
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
Medicare Part A
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
Medicare Part B
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
POS
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
PPO
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
blue cross blue shield - medicare advantage
Workers Comp
O
34.27
2.63
7.20
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
EPO
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
HMO
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
Medicaid
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
Medicare Part A
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
Medicare Part B
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
POS
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
PPO
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
humana - medicare advantage
Workers Comp
O
34.27
2.63
3.93
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
EPO
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
HMO
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
Medicaid
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
Medicare Part A
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
Medicare Part B
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
POS
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
PPO
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
tricare
Workers Comp
O
34.27
2.63
3.95
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
EPO
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
HMO
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
Medicaid
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
Medicare Part A
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
Medicare Part B
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
POS
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
PPO
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82947
null
cpt
Blood glucose (sugar) level
va
Workers Comp
O
34.27
2.63
2.63
7.28
4.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
EPO
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
HMO
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
Medicaid
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
Medicare Part A
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
Medicare Part B
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
POS
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
PPO
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
aetna
Workers Comp
O
36.72
3.96
21.30
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
EPO
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
HMO
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
Medicaid
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
Medicare Part A
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
Medicare Part B
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
POS
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
PPO
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield
Workers Comp
O
36.72
3.96
8.52
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
EPO
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
HMO
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
Medicaid
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
Medicare Part A
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
Medicare Part B
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
POS
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
PPO
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
blue cross blue shield - medicare advantage
Workers Comp
O
36.72
3.96
7.11
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
EPO
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
HMO
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
Medicaid
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
Medicare Part A
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
Medicare Part B
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
POS
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
PPO
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
cigna
Workers Comp
O
36.72
3.96
25.99
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
EPO
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
HMO
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
Medicaid
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
Medicare Part A
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
Medicare Part B
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
POS
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
PPO
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
humana - medicare advantage
Workers Comp
O
36.72
3.96
4.75
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
EPO
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
HMO
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
Medicaid
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
Medicare Part A
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
Medicare Part B
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
POS
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
PPO
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
tricare
Workers Comp
O
36.72
3.96
4.77
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
EPO
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
HMO
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
Medicaid
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
Medicare Part A
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
Medicare Part B
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
POS
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
PPO
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
united healthcare
Workers Comp
O
36.72
3.96
26.24
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
EPO
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
HMO
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
Medicaid
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
Medicare Part A
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
Medicare Part B
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
POS
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
PPO
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82950
null
cpt
Blood glucose (sugar) level after receiving dose of glucose
va
Workers Comp
O
36.72
3.96
3.96
26.24
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
EPO
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
HMO
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
Medicaid
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
Medicare Part A
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
Medicare Part B
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
POS
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
PPO
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
aetna
Workers Comp
O
110.96
12.87
63.70
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
EPO
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
HMO
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
Medicaid
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
Medicare Part A
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
Medicare Part B
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
POS
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
PPO
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield
Workers Comp
O
110.96
12.87
24.22
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
EPO
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
HMO
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
Medicaid
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
Medicare Part A
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
Medicare Part B
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
POS
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
PPO
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
blue cross blue shield - medicare advantage
Workers Comp
O
110.96
12.87
24.63
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
EPO
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
HMO
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
Medicaid
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
Medicare Part A
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
Medicare Part B
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
POS
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
PPO
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
humana - medicare advantage
Workers Comp
O
110.96
12.87
12.87
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
EPO
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
HMO
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
Medicaid
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
Medicare Part A
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
Medicare Part B
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
POS
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
PPO
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
tricare
Workers Comp
O
110.96
12.87
12.92
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
EPO
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
HMO
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
Medicaid
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
Medicare Part A
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
Medicare Part B
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
POS
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
PPO
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82951
null
cpt
Blood glucose (sugar) tolerance test 3 specimens
united healthcare
Workers Comp
O
110.96
12.87
80.97
80.97
15.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
EPO
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
HMO
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
Medicaid
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
Medicare Part A
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
Medicare Part B
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
POS
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
PPO
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
aetna
Workers Comp
O
45.63
3.94
26.61
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
EPO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
HMO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
Medicaid
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
Medicare Part A
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
Medicare Part B
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
POS
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
PPO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield
Workers Comp
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
EPO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
HMO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
Medicaid
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
Medicare Part A
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
Medicare Part B
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
POS
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
PPO
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
blue cross blue shield - medicare advantage
Workers Comp
O
45.63
3.94
10.39
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
EPO
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
HMO
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
Medicaid
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
Medicare Part A
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
Medicare Part B
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
POS
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
PPO
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
tricare
Workers Comp
O
45.63
3.94
3.94
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
EPO
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
HMO
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
Medicaid
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
Medicare Part A
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
Medicare Part B
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
POS
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
PPO
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82952
null
cpt
Blood glucose (sugar) tolerance test each additional beyond 3 specimens
united healthcare
Workers Comp
O
45.63
3.94
33.41
33.41
4.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
EPO
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
HMO
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
POS
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
PPO
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
5.84
18.28
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
EPO
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
HMO
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
Medicaid
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
Medicare Part A
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
Medicare Part B
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
POS
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
PPO
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82955
null
cpt
G6PD (enzyme) level
va
Workers Comp
O
95.71
5.84
5.84
18.28
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
EPO
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
HMO
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
Medicaid
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
Medicare Part A
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
Medicare Part B
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
POS
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
PPO
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna
Workers Comp
O
40.17
3.28
23.30
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
EPO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
HMO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
Medicaid
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
Medicare Part A
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
Medicare Part B
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
POS
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
PPO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
aetna - medicare advantage
Workers Comp
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
EPO
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
HMO
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
Medicaid
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
Medicare Part A
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
Medicare Part B
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
POS
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
PPO
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield
Workers Comp
O
40.17
3.28
15.46
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
EPO
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
HMO
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
Medicaid
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
Medicare Part A
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
Medicare Part B
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
POS
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
PPO
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
blue cross blue shield - medicare advantage
Workers Comp
O
40.17
3.28
13.45
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
EPO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
HMO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
Medicaid
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
Medicare Part A
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
Medicare Part B
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
POS
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
PPO
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
humana - medicare advantage
Workers Comp
O
40.17
3.28
3.28
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
EPO
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
HMO
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
Medicaid
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
Medicare Part A
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
Medicare Part B
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
POS
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
PPO
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
tricare
Workers Comp
O
40.17
3.28
3.29
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
EPO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
HMO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
Medicaid
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
Medicare Part A
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
Medicare Part B
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
POS
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
PPO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
united healthcare
Workers Comp
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
EPO
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
HMO
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
Medicaid
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
Medicare Part A
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
Medicare Part B
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
POS
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
PPO
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
va
Workers Comp
O
40.17
3.28
38.26
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
EPO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
HMO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
Medicaid
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
Medicare Part A
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
Medicare Part B
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
POS
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
PPO
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82962
null
cpt
Blood glucose (sugar) test performed by hand-held instrument
worker comp
Workers Comp
O
40.17
3.28
28.70
38.26
3.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
EPO
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
HMO
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
Medicaid
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
Medicare Part A
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
Medicare Part B
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
POS
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
PPO
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield
Workers Comp
O
38.26
5.24
5.24
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
EPO
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
HMO
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
POS
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
PPO
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
38.26
5.24
5.41
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
EPO
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
HMO
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
Medicaid
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
Medicare Part A
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
Medicare Part B
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
POS
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
PPO
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
humana - medicare advantage
Workers Comp
O
38.26
5.24
7.20
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
EPO
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
HMO
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
Medicaid
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
Medicare Part A
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
Medicare Part B
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
POS
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
PPO
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
tricare
Workers Comp
O
38.26
5.24
7.23
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
EPO
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
HMO
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
Medicaid
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
Medicare Part A
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
Medicare Part B
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
POS
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
PPO
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
united healthcare
Workers Comp
O
38.26
5.24
30.13
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
EPO
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
HMO
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
Medicaid
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
Medicare Part A
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
Medicare Part B
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
POS
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
PPO
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82977
null
cpt
Glutamyltransferase (liver enzyme) level
va
Workers Comp
O
38.26
5.24
5.77
30.13
8.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
EPO
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
HMO
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
Medicaid
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
Medicare Part A
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
Medicare Part B
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
POS
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
PPO
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
82985
null
cpt
Glycated protein level
humana - medicare advantage
Workers Comp
O
41.90
16.76
16.76
16.76
25.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
EPO
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
HMO
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
Medicaid
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
Medicare Part A
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
Medicare Part B
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
POS
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
PPO
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
aetna
Workers Comp
O
97.94
14.89
56.81
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
EPO
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
HMO
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
Medicaid
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
Medicare Part A
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
Medicare Part B
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
POS
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
PPO
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield
Workers Comp
O
97.94
14.89
20.24
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
EPO
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
HMO
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
POS
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
PPO
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
97.94
14.89
19.48
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
EPO
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
HMO
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
Medicaid
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
Medicare Part A
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
Medicare Part B
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
POS
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
PPO
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
healthchoice
Workers Comp
O
97.94
14.89
23.21
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
EPO
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
HMO
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
Medicaid
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
Medicare Part A
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
Medicare Part B
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
POS
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
PPO
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
humana - medicare advantage
Workers Comp
O
97.94
14.89
18.58
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
EPO
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
HMO
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
Medicaid
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
Medicare Part A
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
Medicare Part B
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
POS
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
PPO
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
tricare
Workers Comp
O
97.94
14.89
18.66
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
EPO
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
HMO
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
Medicaid
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
Medicare Part A
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
Medicare Part B
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
POS
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
PPO
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
united healthcare
Workers Comp
O
97.94
14.89
69.96
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
EPO
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
HMO
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
Medicaid
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
Medicare Part A
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
Medicare Part B
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
POS
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
PPO
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
va
Workers Comp
O
97.94
14.89
14.89
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
EPO
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
HMO
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
Medicaid
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
Medicare Part A
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
Medicare Part B
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
POS
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
PPO
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83001
null
cpt
Gonadotropin follicle stimulating (reproductive hormone) level
webtpa
Workers Comp
O
97.94
14.89
65.30
69.96
22.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
EPO
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
HMO
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
Medicaid
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
Medicare Part A
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
Medicare Part B
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
POS
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
PPO
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
aetna
Workers Comp
O
235.95
11.16
136.85
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
EPO
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
HMO
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
Medicaid
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
Medicare Part A
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
Medicare Part B
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
POS
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
PPO
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield
Workers Comp
O
235.95
11.16
41.73
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
EPO
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
HMO
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
POS
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
PPO
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
235.95
11.16
42.14
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
EPO
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
HMO
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
Medicaid
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
Medicare Part A
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
Medicare Part B
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
POS
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
PPO
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
humana - medicare advantage
Workers Comp
O
235.95
11.16
18.52
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
EPO
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
HMO
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
Medicaid
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
Medicare Part A
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
Medicare Part B
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
POS
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
PPO
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
tricare
Workers Comp
O
235.95
11.16
18.60
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
EPO
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
HMO
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
Medicaid
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
Medicare Part A
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
Medicare Part B
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
POS
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
PPO
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
united healthcare
Workers Comp
O
235.95
11.16
168.54
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
EPO
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
HMO
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
Medicaid
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
Medicare Part A
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
Medicare Part B
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
POS
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
PPO
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
va
Workers Comp
O
235.95
11.16
11.16
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
EPO
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
HMO
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
Medicaid
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
Medicare Part A
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
Medicare Part B
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
POS
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
PPO
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83002
null
cpt
Gonadotropin luteinizing (reproductive hormone) level
webtpa
Workers Comp
O
235.95
11.16
157.30
168.54
22.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
EPO
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
HMO
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
Medicaid
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
Medicare Part A
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
Medicare Part B
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
POS
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
PPO
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
aetna
Workers Comp
O
80.13
8.60
48.41
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
EPO
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
HMO
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
Medicaid
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
Medicare Part A
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
Medicare Part B
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
POS
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
PPO
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield
Workers Comp
O
80.13
8.60
8.60
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
EPO
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
HMO
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
Medicaid
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
POS
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
PPO
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
80.13
8.60
10.84
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
EPO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
HMO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
Medicaid
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
Medicare Part A
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
Medicare Part B
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
POS
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
PPO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
humana - medicare advantage
Workers Comp
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
EPO
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
HMO
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
Medicaid
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
Medicare Part A
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
Medicare Part B
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
POS
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
PPO
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
tricare
Workers Comp
O
80.13
8.60
12.63
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
EPO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
HMO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
Medicaid
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
Medicare Part A
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
Medicare Part B
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
POS
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
PPO
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83010
null
cpt
Haptoglobin (serum protein) level
va
Workers Comp
O
80.13
8.60
12.58
48.41
15.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
EPO
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
HMO
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
Medicaid
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
Medicare Part A
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
Medicare Part B
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
POS
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
PPO
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield
Workers Comp
O
123.54
15.29
19.38
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
EPO
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
HMO
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
Medicaid
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
Medicare Part A
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
Medicare Part B
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
POS
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
PPO
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
blue cross blue shield - medicare advantage
Workers Comp
O
123.54
15.29
15.29
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
EPO
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
HMO
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
Medicaid
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
Medicare Part A
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
Medicare Part B
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
POS
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
PPO
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
humana - medicare advantage
Workers Comp
O
123.54
15.29
18.06
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
EPO
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
HMO
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
Medicaid
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
Medicare Part A
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
Medicare Part B
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
POS
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
PPO
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
tricare
Workers Comp
O
123.54
15.29
18.13
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
EPO
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
HMO
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
Medicaid
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
Medicare Part A
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
Medicare Part B
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
POS
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
PPO
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83021
null
cpt
Hemoglobin analysis and measurement chromatography
united healthcare
Workers Comp
O
123.54
15.29
88.25
88.25
21.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
EPO
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
HMO
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
Medicaid
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
Medicare Part A
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
Medicare Part B
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
POS
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
PPO
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna
Workers Comp
O
72.34
5.83
41.96
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
EPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
HMO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
Medicaid
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
Medicare Part A
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
Medicare Part B
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
POS
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
PPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
aetna - medicare advantage
Workers Comp
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
EPO
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
HMO
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
Medicaid
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
Medicare Part A
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
Medicare Part B
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
POS
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
PPO
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield
Workers Comp
O
72.34
5.83
14.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
EPO
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
HMO
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
Medicaid
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
Medicare Part A
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
Medicare Part B
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
POS
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
PPO
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
blue cross blue shield - medicare advantage
Workers Comp
O
72.34
5.83
13.15
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
EPO
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
HMO
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
Medicaid
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
Medicare Part A
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
Medicare Part B
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
POS
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
PPO
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
cigna
Workers Comp
O
72.34
5.83
51.19
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
EPO
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
HMO
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
Medicaid
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
Medicare Part A
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
Medicare Part B
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
POS
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
PPO
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
healthchoice
Workers Comp
O
72.34
5.83
17.28
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
EPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
HMO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
Medicaid
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
Medicare Part A
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
Medicare Part B
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
POS
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
PPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana
Workers Comp
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
EPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
HMO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
Medicaid
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
Medicare Part A
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
Medicare Part B
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
POS
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
PPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
humana - medicare advantage
Workers Comp
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
EPO
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
HMO
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
Medicaid
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
Medicare Part A
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
Medicare Part B
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
POS
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
PPO
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
medica
Workers Comp
O
72.34
5.83
5.83
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
EPO
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
HMO
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
Medicaid
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
Medicare Part A
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
Medicare Part B
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
POS
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
PPO
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
tricare
Workers Comp
O
72.34
5.83
9.75
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
EPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
HMO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
Medicaid
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
Medicare Part A
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
Medicare Part B
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
POS
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
PPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare
Workers Comp
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
EPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
HMO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
Medicaid
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
Medicare Part A
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
Medicare Part B
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
POS
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
PPO
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
united healthcare - medicare advantage
Workers Comp
O
72.34
5.83
9.71
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
EPO
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
HMO
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
Medicaid
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
Medicare Part A
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
Medicare Part B
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
POS
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
PPO
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
va
Workers Comp
O
72.34
5.83
5.85
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
EPO
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
HMO
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
Medicaid
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
Medicare Part A
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
Medicare Part B
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
POS
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
PPO
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
webtpa
Workers Comp
O
72.34
5.83
48.23
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
EPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
HMO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
Medicaid
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
Medicare Part A
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
Medicare Part B
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
POS
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
PPO
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83036
null
cpt
Hemoglobin A1C level
worker comp
Workers Comp
O
72.34
5.83
51.68
51.68
11.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
EPO
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
HMO
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
Medicaid
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
Medicare Part A
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
Medicare Part B
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
POS
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
PPO
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
blue cross blue shield
Workers Comp
O
43.40
10.54
10.54
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
EPO
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
HMO
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
Medicaid
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
Medicare Part A
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
Medicare Part B
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
POS
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
PPO
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83090
null
cpt
Homocysteine (amino acid) level
tricare
Workers Comp
O
43.40
10.54
17.99
17.99
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
EPO
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
HMO
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
Medicaid
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
Medicare Part A
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
Medicare Part B
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
POS
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
PPO
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
831
null
ms-drg
other antepartum diagnoses without o.r. procedures with mcc
tricare
Workers Comp
I
14171.64
4116.24
4116.24
4116.24
8502.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
EPO
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
HMO
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
Medicaid
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
Medicare Part A
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
Medicare Part B
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
POS
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
PPO
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
tricare
Workers Comp
I
10245.87
2843.07
2843.07
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
EPO
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
HMO
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
Medicaid
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
Medicare Part A
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
Medicare Part B
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
POS
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
PPO
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
832
null
ms-drg
other antepartum diagnoses without o.r. procedures with cc
united healthcare
Workers Comp
I
10245.87
2843.07
7684.40
7684.40
6147.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
EPO
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
HMO
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
Medicaid
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
POS
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
PPO
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
blue cross blue shield
Workers Comp
I
7428.59
2030.00
3766.35
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
EPO
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
HMO
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
Medicaid
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
Medicare Part A
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
Medicare Part B
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
POS
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
PPO
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
833
null
ms-drg
other antepartum diagnoses without o.r. procedures without cc/mcc
tricare
Workers Comp
I
7428.59
2030.00
2030.00
3766.35
4457.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
EPO
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
HMO
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
Medicaid
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
Medicare Part A
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
Medicare Part B
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
POS
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
PPO
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
834
null
ms-drg
acute leukemia without major o.r. procedures with mcc
humana - medicare advantage
Workers Comp
I
48802.09
28861.08
28861.08
28861.08
29281.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
EPO
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
HMO
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
Medicaid
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
Medicare Part A
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
Medicare Part B
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
POS
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
PPO
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield
Workers Comp
O
200.34
12.90
25.70
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
EPO
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
HMO
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
Medicaid
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
Medicare Part A
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
Medicare Part B
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
POS
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
PPO
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
blue cross blue shield - medicare advantage
Workers Comp
O
200.34
12.90
21.71
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
EPO
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
HMO
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
Medicaid
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
Medicare Part A
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
Medicare Part B
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
POS
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
PPO
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
humana - medicare advantage
Workers Comp
O
200.34
12.90
12.90
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
EPO
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
HMO
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
Medicaid
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
Medicare Part A
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
Medicare Part B
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
POS
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
PPO
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83497
null
cpt
Hydroxyindolacetic acid (product of metabolism) level
tricare
Workers Comp
O
200.34
12.90
13.67
25.70
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
EPO
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
HMO
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
Medicaid
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
Medicare Part A
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
Medicare Part B
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
POS
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
PPO
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
aetna
Workers Comp
O
119.09
16.24
69.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
EPO
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
HMO
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
Medicaid
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
Medicare Part A
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
Medicare Part B
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
POS
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
PPO
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield
Workers Comp
O
119.09
16.24
20.81
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
EPO
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
HMO
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
POS
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
PPO
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
119.09
16.24
16.24
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
EPO
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
HMO
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
Medicaid
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
Medicare Part A
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
Medicare Part B
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
POS
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
PPO
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
tricare
Workers Comp
O
119.09
16.24
27.28
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
EPO
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
HMO
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
Medicaid
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
Medicare Part A
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
Medicare Part B
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
POS
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
PPO
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
united healthcare
Workers Comp
O
119.09
16.24
85.07
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
EPO
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
HMO
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
Medicaid
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
Medicare Part A
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
Medicare Part B
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
POS
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
PPO
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83498
null
cpt
Hydroxyprogesterone 17-D (synthetic hormone) level
va
Workers Comp
O
119.09
16.24
27.17
85.07
71.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
EPO
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
HMO
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
Medicaid
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
Medicare Part A
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
Medicare Part B
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
POS
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
PPO
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna
Workers Comp
O
48.41
8.58
29.25
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
EPO
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
HMO
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
Medicaid
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
Medicare Part A
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
Medicare Part B
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
POS
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
PPO
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
aetna - medicare advantage
Workers Comp
O
48.41
8.58
11.42
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
EPO
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
HMO
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
Medicaid
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
Medicare Part A
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
Medicare Part B
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
POS
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
PPO
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield
Workers Comp
O
48.41
8.58
10.80
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
EPO
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
HMO
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
Medicaid
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
Medicare Part A
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
Medicare Part B
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
POS
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
PPO
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
blue cross blue shield - medicare advantage
Workers Comp
O
48.41
8.58
8.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
EPO
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
HMO
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
Medicaid
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
Medicare Part A
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
Medicare Part B
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
POS
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
PPO
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
healthchoice
Workers Comp
O
48.41
8.58
9.38
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
EPO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
HMO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
Medicaid
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
Medicare Part A
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
Medicare Part B
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
POS
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
PPO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
humana - medicare advantage
Workers Comp
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
EPO
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
HMO
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
Medicaid
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
Medicare Part A
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
Medicare Part B
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
POS
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
PPO
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
tricare
Workers Comp
O
48.41
8.58
11.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
EPO
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
HMO
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
Medicaid
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
Medicare Part A
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
Medicare Part B
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
POS
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
PPO
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare
Workers Comp
O
48.41
8.58
34.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
EPO
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
HMO
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
Medicaid
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
Medicare Part A
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
Medicare Part B
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
POS
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
PPO
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
united healthcare - medicare advantage
Workers Comp
O
48.41
8.58
12.58
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
EPO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
HMO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
Medicaid
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
Medicare Part A
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
Medicare Part B
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
POS
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
PPO
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83516
null
cpt
Analysis of substance using immunoassay technique multiple step method
va
Workers Comp
O
48.41
8.58
11.53
34.58
13.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
EPO
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
HMO
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
Medicaid
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
Medicare Part A
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
Medicare Part B
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
POS
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
PPO
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
aetna
Workers Comp
O
198.11
18.40
203.26
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
EPO
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
HMO
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
Medicaid
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
Medicare Part A
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
Medicare Part B
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
POS
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
PPO
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield
Workers Comp
O
198.11
18.40
34.85
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
EPO
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
HMO
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
Medicaid
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
Medicare Part A
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
Medicare Part B
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
POS
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
PPO
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
blue cross blue shield - medicare advantage
Workers Comp
O
198.11
18.40
40.96
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
EPO
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
HMO
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
Medicaid
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
Medicare Part A
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
Medicare Part B
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
POS
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
PPO
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
humana - medicare advantage
Workers Comp
O
198.11
18.40
18.40
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
EPO
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
HMO
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
Medicaid
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
Medicare Part A
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
Medicare Part B
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
POS
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
PPO
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83519
null
cpt
Measurement of substance using immunoassay technique by radioimmunoassay
tricare
Workers Comp
O
198.11
18.40
18.48
203.26
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
EPO
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
HMO
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
Medicaid
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
Medicare Part A
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
Medicare Part B
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
POS
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
PPO
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield
Workers Comp
O
43.18
8.82
14.08
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
EPO
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
HMO
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
Medicaid
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
Medicare Part A
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
Medicare Part B
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
POS
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
PPO
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
blue cross blue shield - medicare advantage
Workers Comp
O
43.18
8.82
8.82
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
EPO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
HMO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
Medicaid
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
Medicare Part A
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
Medicare Part B
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
POS
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
PPO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
humana - medicare advantage
Workers Comp
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
EPO
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
HMO
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
Medicaid
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
Medicare Part A
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
Medicare Part B
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
POS
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
PPO
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
tricare
Workers Comp
O
43.18
8.82
17.34
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
EPO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
HMO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
Medicaid
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
Medicare Part A
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
Medicare Part B
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
POS
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
PPO
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83520
null
cpt
Measurement of substance using immunoassay technique
va
Workers Comp
O
43.18
8.82
17.27
17.34
25.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
EPO
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
HMO
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
Medicaid
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
Medicare Part A
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
Medicare Part B
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
POS
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
PPO
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield
Workers Comp
O
95.71
11.43
20.45
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
EPO
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
HMO
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
Medicaid
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
POS
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
PPO
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
11.43
25.72
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
EPO
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
HMO
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
Medicaid
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
Medicare Part A
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
Medicare Part B
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
POS
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
PPO
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
humana - medicare advantage
Workers Comp
O
95.71
11.43
11.43
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
EPO
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
HMO
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
Medicaid
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
Medicare Part A
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
Medicare Part B
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
POS
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
PPO
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
tricare
Workers Comp
O
95.71
11.43
11.48
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
EPO
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
HMO
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
Medicaid
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
Medicare Part A
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
Medicare Part B
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
POS
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
PPO
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
united healthcare
Workers Comp
O
95.71
11.43
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
EPO
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
HMO
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
Medicaid
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
Medicare Part A
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
Medicare Part B
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
POS
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
PPO
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83525
null
cpt
Insulin measurement total
webtpa
Workers Comp
O
95.71
11.43
67.00
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
EPO
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
HMO
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
Medicaid
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
Medicare Part A
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
Medicare Part B
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
POS
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
PPO
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna
Workers Comp
O
38.95
4.41
22.59
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
EPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
HMO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
Medicaid
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
Medicare Part A
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
Medicare Part B
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
POS
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
PPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
aetna - medicare advantage
Workers Comp
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
EPO
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
HMO
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
Medicaid
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
Medicare Part A
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
Medicare Part B
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
POS
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
PPO
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield
Workers Comp
O
38.95
4.41
9.39
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
EPO
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
HMO
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
Medicaid
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
Medicare Part A
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
Medicare Part B
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
POS
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
PPO
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
blue cross blue shield - medicare advantage
Workers Comp
O
38.95
4.41
7.26
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
EPO
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
HMO
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
Medicaid
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
Medicare Part A
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
Medicare Part B
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
POS
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
PPO
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
cigna
Workers Comp
O
38.95
4.41
26.01
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
EPO
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
HMO
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
Medicaid
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
Medicare Part A
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
Medicare Part B
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
POS
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
PPO
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
healthchoice
Workers Comp
O
38.95
4.41
4.41
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
EPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
HMO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
Medicaid
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
Medicare Part A
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
Medicare Part B
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
POS
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
PPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
humana - medicare advantage
Workers Comp
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
EPO
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
HMO
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
Medicaid
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
Medicare Part A
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
Medicare Part B
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
POS
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
PPO
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
tricare
Workers Comp
O
38.95
4.41
6.50
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
EPO
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
HMO
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
Medicaid
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
Medicare Part A
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
Medicare Part B
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
POS
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
PPO
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare
Workers Comp
O
38.95
4.41
27.83
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
EPO
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
HMO
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
Medicaid
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
Medicare Part A
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
Medicare Part B
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
POS
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
PPO
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
united healthcare - medicare advantage
Workers Comp
O
38.95
4.41
7.05
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
EPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
HMO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
Medicaid
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
Medicare Part A
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
Medicare Part B
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
POS
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
PPO
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
va
Workers Comp
O
38.95
4.41
6.47
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
EPO
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
HMO
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
Medicaid
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
Medicare Part A
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
Medicare Part B
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
POS
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
PPO
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83540
null
cpt
Iron level
webtpa
Workers Comp
O
38.95
4.41
7.66
27.83
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
EPO
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
HMO
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
Medicaid
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
Medicare Part A
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
Medicare Part B
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
POS
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
PPO
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna
Workers Comp
O
100.27
8.74
58.16
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
EPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
HMO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
Medicaid
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
Medicare Part A
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
Medicare Part B
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
POS
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
PPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
aetna - medicare advantage
Workers Comp
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
EPO
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
HMO
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
Medicaid
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
Medicare Part A
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
Medicare Part B
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
POS
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
PPO
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield
Workers Comp
O
100.27
8.74
24.18
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
EPO
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
HMO
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
Medicaid
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
Medicare Part A
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
Medicare Part B
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
POS
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
PPO
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
blue cross blue shield - medicare advantage
Workers Comp
O
100.27
8.74
18.70
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
EPO
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
HMO
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
Medicaid
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
Medicare Part A
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
Medicare Part B
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
POS
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
PPO
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
cigna
Workers Comp
O
100.27
8.74
66.95
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
EPO
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
HMO
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
Medicaid
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
Medicare Part A
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
Medicare Part B
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
POS
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
PPO
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
healthchoice
Workers Comp
O
100.27
8.74
11.37
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
EPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
HMO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
Medicaid
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
Medicare Part A
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
Medicare Part B
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
POS
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
PPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
humana - medicare advantage
Workers Comp
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
EPO
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
HMO
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
Medicaid
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
Medicare Part A
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
Medicare Part B
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
POS
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
PPO
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
tricare
Workers Comp
O
100.27
8.74
8.78
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
EPO
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
HMO
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
Medicaid
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
Medicare Part A
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
Medicare Part B
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
POS
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
PPO
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare
Workers Comp
O
100.27
8.74
71.63
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
EPO
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
HMO
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
Medicaid
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
Medicare Part A
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
Medicare Part B
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
POS
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
PPO
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
united healthcare - medicare advantage
Workers Comp
O
100.27
8.74
9.52
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
EPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
HMO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
Medicaid
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
Medicare Part A
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
Medicare Part B
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
POS
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
PPO
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
va
Workers Comp
O
100.27
8.74
8.74
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
EPO
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
HMO
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
Medicaid
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
Medicare Part A
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
Medicare Part B
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
POS
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
PPO
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83550
null
cpt
Iron binding capacity
webtpa
Workers Comp
O
100.27
8.74
19.72
71.63
10.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
EPO
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
HMO
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
Medicaid
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
Medicare Part A
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
Medicare Part B
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
POS
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
PPO
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
aetna - medicare advantage
Workers Comp
O
67.89
11.63
11.63
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
EPO
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
HMO
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
Medicaid
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
POS
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
PPO
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
11.63
12.38
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
EPO
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
HMO
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
Medicaid
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
Medicare Part A
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
Medicare Part B
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
POS
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
PPO
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83605
null
cpt
Lactic acid level
united healthcare
Workers Comp
O
67.89
11.63
50.92
50.92
13.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
EPO
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
HMO
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
Medicaid
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
Medicare Part A
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
Medicare Part B
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
POS
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
PPO
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna
Workers Comp
O
50.72
6.04
28.91
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
EPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
HMO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
Medicaid
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
Medicare Part A
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
Medicare Part B
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
POS
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
PPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
aetna - medicare advantage
Workers Comp
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
EPO
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
HMO
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
Medicaid
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
Medicare Part A
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
Medicare Part B
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
POS
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
PPO
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield
Workers Comp
O
50.72
6.04
8.63
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
EPO
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
HMO
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
POS
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
PPO
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
50.72
6.04
8.60
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
EPO
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
HMO
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
Medicaid
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
Medicare Part A
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
Medicare Part B
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
POS
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
PPO
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
cigna
Workers Comp
O
50.72
6.04
69.83
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
EPO
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
HMO
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
Medicaid
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
Medicare Part A
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
Medicare Part B
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
POS
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
PPO
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
healthchoice
Workers Comp
O
50.72
6.04
79.41
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
EPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
HMO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
Medicaid
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
Medicare Part A
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
Medicare Part B
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
POS
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
PPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
humana - medicare advantage
Workers Comp
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
EPO
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
HMO
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
Medicaid
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
Medicare Part A
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
Medicare Part B
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
POS
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
PPO
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
tricare
Workers Comp
O
50.72
6.04
6.06
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
EPO
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
HMO
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
Medicaid
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
Medicare Part A
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
Medicare Part B
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
POS
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
PPO
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
united healthcare
Workers Comp
O
50.72
6.04
76.32
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
EPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
HMO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
Medicaid
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
Medicare Part A
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
Medicare Part B
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
POS
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
PPO
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83615
null
cpt
Lactate dehydrogenase (enzyme) level
va
Workers Comp
O
50.72
6.04
6.04
79.41
7.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
EPO
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
HMO
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
Medicaid
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
Medicare Part A
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
Medicare Part B
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
POS
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
PPO
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna
Workers Comp
O
65.66
8.10
36.90
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
EPO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
HMO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
Medicaid
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
Medicare Part A
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
Medicare Part B
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
POS
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
PPO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
aetna - medicare advantage
Workers Comp
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
EPO
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
HMO
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
Medicaid
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
Medicare Part A
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
Medicare Part B
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
POS
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
PPO
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield
Workers Comp
O
65.66
8.10
8.10
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
EPO
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
HMO
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
Medicaid
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
Medicare Part A
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
Medicare Part B
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
POS
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
PPO
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
blue cross blue shield - medicare advantage
Workers Comp
O
65.66
8.10
9.13
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
EPO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
HMO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
Medicaid
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
Medicare Part A
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
Medicare Part B
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
POS
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
PPO
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
humana - medicare advantage
Workers Comp
O
65.66
8.10
19.70
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
EPO
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
HMO
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
Medicaid
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
Medicare Part A
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
Medicare Part B
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
POS
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
PPO
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
tricare
Workers Comp
O
65.66
8.10
20.84
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
EPO
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
HMO
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
Medicaid
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
Medicare Part A
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
Medicare Part B
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
POS
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
PPO
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83630
null
cpt
Stool lactoferrin (immune system protein) analysis
united healthcare
Workers Comp
O
65.66
8.10
48.08
48.08
23.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
EPO
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
HMO
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
Medicaid
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
Medicare Part A
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
Medicare Part B
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
POS
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
PPO
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
blue cross blue shield - medicare advantage
Workers Comp
O
56.76
11.45
11.45
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
EPO
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
HMO
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
Medicaid
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
Medicare Part A
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
Medicare Part B
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
POS
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
PPO
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83655
null
cpt
Lead level
tricare
Workers Comp
O
56.76
11.45
12.16
12.16
14.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
EPO
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
HMO
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
Medicaid
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
Medicare Part A
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
Medicare Part B
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
POS
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
PPO
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna
Workers Comp
O
49.63
4.15
42.56
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
EPO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
HMO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
Medicaid
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
Medicare Part A
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
Medicare Part B
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
POS
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
PPO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
aetna - medicare advantage
Workers Comp
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
EPO
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
HMO
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
Medicaid
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
Medicare Part A
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
Medicare Part B
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
POS
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
PPO
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield
Workers Comp
O
49.63
4.15
9.61
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
EPO
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
HMO
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
Medicaid
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
Medicare Part A
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
Medicare Part B
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
POS
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
PPO
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
blue cross blue shield - medicare advantage
Workers Comp
O
49.63
4.15
10.98
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
EPO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
HMO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
Medicaid
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
Medicare Part A
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
Medicare Part B
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
POS
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
PPO
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
humana - medicare advantage
Workers Comp
O
49.63
4.15
6.89
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
EPO
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
HMO
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
Medicaid
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
Medicare Part A
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
Medicare Part B
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
POS
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
PPO
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
tricare
Workers Comp
O
49.63
4.15
6.92
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
EPO
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
HMO
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
Medicaid
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
Medicare Part A
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
Medicare Part B
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
POS
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
PPO
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
united healthcare
Workers Comp
O
49.63
4.15
35.45
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
EPO
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
HMO
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
Medicaid
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
Medicare Part A
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
Medicare Part B
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
POS
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
PPO
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83690
null
cpt
Lipase (fat enzyme) level
va
Workers Comp
O
49.63
4.15
4.15
42.56
8.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
EPO
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
HMO
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
Medicaid
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
Medicare Part A
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
Medicare Part B
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
POS
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
PPO
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield
Workers Comp
O
79.02
14.32
14.45
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
EPO
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
HMO
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
Medicaid
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
Medicare Part A
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
Medicare Part B
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
POS
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
PPO
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
blue cross blue shield - medicare advantage
Workers Comp
O
79.02
14.32
30.21
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
EPO
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
HMO
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
Medicaid
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
Medicare Part A
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
Medicare Part B
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
POS
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
PPO
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83695
null
cpt
Lipoprotein (A) level
humana - medicare advantage
Workers Comp
O
79.02
14.32
14.32
30.21
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
EPO
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
HMO
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
Medicaid
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
Medicare Part A
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
Medicare Part B
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
POS
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
PPO
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna
Workers Comp
O
61.43
6.70
35.63
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
EPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
HMO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
Medicaid
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
Medicare Part A
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
Medicare Part B
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
POS
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
PPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
aetna - medicare advantage
Workers Comp
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
EPO
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
HMO
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
Medicaid
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
Medicare Part A
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
Medicare Part B
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
POS
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
PPO
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield
Workers Comp
O
61.43
6.70
11.76
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
EPO
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
HMO
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
Medicaid
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
Medicare Part A
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
Medicare Part B
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
POS
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
PPO
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
blue cross blue shield - medicare advantage
Workers Comp
O
61.43
6.70
14.67
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
EPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
HMO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
Medicaid
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
Medicare Part A
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
Medicare Part B
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
POS
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
PPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
humana - medicare advantage
Workers Comp
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
EPO
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
HMO
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
Medicaid
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
Medicare Part A
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
Medicare Part B
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
POS
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
PPO
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
tricare
Workers Comp
O
61.43
6.70
6.73
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
EPO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
HMO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
Medicaid
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
Medicare Part A
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
Medicare Part B
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
POS
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
PPO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare
Workers Comp
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
EPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
HMO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
Medicaid
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
Medicare Part A
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
Medicare Part B
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
POS
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
PPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
united healthcare - medicare advantage
Workers Comp
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
EPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
HMO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
Medicaid
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
Medicare Part A
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
Medicare Part B
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
POS
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
PPO
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
va
Workers Comp
O
61.43
6.70
6.70
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
EPO
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
HMO
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
Medicaid
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
Medicare Part A
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
Medicare Part B
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
POS
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
PPO
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
webtpa
Workers Comp
O
61.43
6.70
41.98
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
EPO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
HMO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
Medicaid
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
Medicare Part A
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
Medicare Part B
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
POS
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
PPO
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83735
null
cpt
Magnesium level
worker comp
Workers Comp
O
61.43
6.70
43.88
43.88
8.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
EPO
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
HMO
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
Medicaid
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
Medicare Part A
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
Medicare Part B
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
POS
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
PPO
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83825
null
cpt
Mercury level
blue cross blue shield - medicare advantage
Workers Comp
O
124.65
19.14
19.14
19.14
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
EPO
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
HMO
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
Medicaid
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
Medicare Part A
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
Medicare Part B
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
POS
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
PPO
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield
Workers Comp
O
74.57
12.31
12.31
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
EPO
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
HMO
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
Medicaid
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
Medicare Part A
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
Medicare Part B
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
POS
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
PPO
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
blue cross blue shield - medicare advantage
Workers Comp
O
74.57
12.31
19.83
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
EPO
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
HMO
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
Medicaid
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
Medicare Part A
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
Medicare Part B
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
POS
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
PPO
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
humana - medicare advantage
Workers Comp
O
74.57
12.31
16.94
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
EPO
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
HMO
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
Medicaid
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
Medicare Part A
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
Medicare Part B
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
POS
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
PPO
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
tricare
Workers Comp
O
74.57
12.31
17.01
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
EPO
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
HMO
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
Medicaid
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
Medicare Part A
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
Medicare Part B
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
POS
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
PPO
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83835
null
cpt
Metanephrines level
united healthcare
Workers Comp
O
74.57
12.31
53.27
53.27
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
EPO
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
HMO
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
Medicaid
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
Medicare Part A
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
Medicare Part B
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
POS
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
PPO
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83874
null
cpt
Myoglobin (muscle protein) level
blue cross blue shield
Workers Comp
O
42.37
9.82
9.82
9.82
25.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
EPO
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
HMO
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
Medicaid
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
Medicare Part A
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
Medicare Part B
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
POS
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
PPO
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna
Workers Comp
O
122.75
27.95
68.98
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
EPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
HMO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
Medicaid
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
Medicare Part A
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
Medicare Part B
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
POS
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
PPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
aetna - medicare advantage
Workers Comp
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
EPO
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
HMO
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
Medicaid
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
Medicare Part A
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
Medicare Part B
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
POS
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
PPO
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield
Workers Comp
O
122.75
27.95
27.95
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
EPO
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
HMO
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
Medicaid
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
POS
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
PPO
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
122.75
27.95
28.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
EPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
HMO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
Medicaid
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
Medicare Part A
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
Medicare Part B
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
POS
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
PPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
humana - medicare advantage
Workers Comp
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
EPO
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
HMO
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
Medicaid
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
Medicare Part A
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
Medicare Part B
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
POS
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
PPO
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
tricare
Workers Comp
O
122.75
27.95
39.42
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
EPO
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
HMO
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
Medicaid
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
Medicare Part A
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
Medicare Part B
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
POS
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
PPO
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare
Workers Comp
O
122.75
27.95
89.87
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
EPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
HMO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
Medicaid
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
Medicare Part A
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
Medicare Part B
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
POS
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
PPO
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
united healthcare - medicare advantage
Workers Comp
O
122.75
27.95
39.26
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
EPO
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
HMO
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
Medicaid
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
Medicare Part A
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
Medicare Part B
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
POS
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
PPO
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83880
null
cpt
Natriuretic peptide (heart and blood vessel protein) level
va
Workers Comp
O
122.75
27.95
31.46
89.87
47.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
EPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
HMO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
Medicaid
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
Medicare Part A
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
Medicare Part B
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
POS
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
PPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
aetna
Workers Comp
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
EPO
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
HMO
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
Medicaid
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
Medicare Part A
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
Medicare Part B
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
POS
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
PPO
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield
Workers Comp
O
167.48
13.60
13.84
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
EPO
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
HMO
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
Medicaid
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
Medicare Part A
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
Medicare Part B
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
POS
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
PPO
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
blue cross blue shield - medicare advantage
Workers Comp
O
167.48
13.60
14.03
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
EPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
HMO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
Medicaid
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
Medicare Part A
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
Medicare Part B
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
POS
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
PPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
humana - medicare advantage
Workers Comp
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
EPO
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
HMO
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
Medicaid
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
Medicare Part A
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
Medicare Part B
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
POS
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
PPO
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
tricare
Workers Comp
O
167.48
13.60
13.66
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
EPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
HMO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
Medicaid
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
Medicare Part A
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
Medicare Part B
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
POS
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
PPO
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83883
null
cpt
Nephelometry test method using light
va
Workers Comp
O
167.48
13.60
13.60
14.03
32.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
EPO
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
HMO
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
Medicaid
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
Medicare Part A
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
Medicare Part B
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
POS
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
PPO
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83915
null
cpt
Nucleotidase 5' (enzyme) level
blue cross blue shield
Workers Comp
O
27.88
4.17
4.17
4.17
16.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
EPO
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
HMO
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
Medicaid
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
Medicare Part A
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
Medicare Part B
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
POS
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
PPO
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield
Workers Comp
O
96.83
12.09
29.74
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
EPO
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
HMO
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
Medicaid
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
Medicare Part A
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
Medicare Part B
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
POS
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
PPO
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
blue cross blue shield - medicare advantage
Workers Comp
O
96.83
12.09
12.09
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
EPO
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
HMO
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
Medicaid
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
Medicare Part A
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
Medicare Part B
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
POS
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
PPO
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
humana - medicare advantage
Workers Comp
O
96.83
12.09
21.21
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
EPO
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
HMO
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
Medicaid
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
Medicare Part A
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
Medicare Part B
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
POS
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
PPO
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83921
null
cpt
Organic acid level
tricare
Workers Comp
O
96.83
12.09
21.30
29.74
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
EPO
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
HMO
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
Medicaid
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
Medicare Part A
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
Medicare Part B
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
POS
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
PPO
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
blue cross blue shield
Workers Comp
O
112.41
6.61
11.82
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
EPO
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
HMO
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
Medicaid
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
Medicare Part A
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
Medicare Part B
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
POS
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
PPO
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83930
null
cpt
Blood osmolality (concentration) measurement
humana - medicare advantage
Workers Comp
O
112.41
6.61
6.61
11.82
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
EPO
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
HMO
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
Medicaid
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
Medicare Part A
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
Medicare Part B
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
POS
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
PPO
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
blue cross blue shield
Workers Comp
O
95.71
6.82
10.07
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
EPO
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
HMO
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
Medicaid
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
Medicare Part A
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
Medicare Part B
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
POS
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
PPO
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83935
null
cpt
Urine osmolality (concentration) measurement
humana - medicare advantage
Workers Comp
O
95.71
6.82
6.82
10.07
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
EPO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
HMO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
Medicaid
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
Medicare Part A
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
Medicare Part B
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
POS
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
PPO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
aetna
Workers Comp
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
EPO
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
HMO
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
Medicaid
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
Medicare Part A
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
Medicare Part B
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
POS
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
PPO
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield
Workers Comp
O
136.89
27.12
27.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
EPO
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
HMO
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
POS
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
PPO
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
136.89
27.12
38.12
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
EPO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
HMO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
Medicaid
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
Medicare Part A
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
Medicare Part B
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
POS
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
PPO
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
humana - medicare advantage
Workers Comp
O
136.89
27.12
41.28
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
EPO
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
HMO
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
Medicaid
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
Medicare Part A
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
Medicare Part B
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
POS
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
PPO
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
tricare
Workers Comp
O
136.89
27.12
41.45
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
EPO
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
HMO
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
Medicaid
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
Medicare Part A
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
Medicare Part B
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
POS
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
PPO
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83970
null
cpt
Parathormone (parathyroid hormone) level
united healthcare
Workers Comp
O
136.89
27.12
102.67
102.67
49.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
EPO
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
HMO
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
Medicaid
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
Medicare Part A
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
Medicare Part B
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
POS
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
PPO
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83986
null
cpt
Body fluid pH level
humana - medicare advantage
Workers Comp
O
8.95
3.58
3.58
3.58
5.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
EPO
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
HMO
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
Medicaid
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
Medicare Part A
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
Medicare Part B
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
POS
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
PPO
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83992
null
cpt
PCP drug level
blue cross blue shield
Workers Comp
O
250.77
11.17
11.17
11.17
150.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
EPO
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
HMO
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
Medicaid
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
Medicare Part A
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
Medicare Part B
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
POS
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
PPO
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
aetna
Workers Comp
O
101.28
12.65
56.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
EPO
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
HMO
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
Medicaid
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
Medicare Part A
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
Medicare Part B
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
POS
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
PPO
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield
Workers Comp
O
101.28
12.65
30.91
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
EPO
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
HMO
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
POS
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
PPO
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
101.28
12.65
12.65
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
EPO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
HMO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
Medicaid
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
Medicare Part A
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
Medicare Part B
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
POS
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
PPO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
humana - medicare advantage
Workers Comp
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
EPO
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
HMO
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
Medicaid
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
Medicare Part A
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
Medicare Part B
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
POS
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
PPO
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
tricare
Workers Comp
O
101.28
12.65
19.71
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
EPO
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
HMO
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
Medicaid
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
Medicare Part A
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
Medicare Part B
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
POS
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
PPO
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
united healthcare
Workers Comp
O
101.28
12.65
72.35
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
EPO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
HMO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
Medicaid
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
Medicare Part A
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
Medicare Part B
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
POS
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
PPO
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
83993
null
cpt
Stool calprotectin (protein) level
va
Workers Comp
O
101.28
12.65
19.63
72.35
23.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
EPO
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
HMO
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
Medicaid
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
Medicare Part A
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
Medicare Part B
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
POS
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
PPO
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
840
null
ms-drg
lymphoma and non-acute leukemia with mcc
tricare
Workers Comp
I
111632.72
24876.86
24876.86
24876.86
66979.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
EPO
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
HMO
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
Medicaid
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
Medicare Part A
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
Medicare Part B
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
POS
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
PPO
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84080
null
cpt
Phosphatase (enzyme) measurement alkaline isoenzymes
tricare
Workers Comp
O
36.95
14.84
14.84
14.84
22.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
EPO
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
HMO
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
Medicaid
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
Medicare Part A
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
Medicare Part B
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
POS
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
PPO
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
841
null
ms-drg
lymphoma and non-acute leukemia with cc
tricare
Workers Comp
I
16347.86
12578.51
12578.51
12578.51
9808.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
EPO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
HMO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
Medicaid
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
Medicare Part A
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
Medicare Part B
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
POS
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
PPO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
aetna
Workers Comp
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
EPO
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
HMO
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
Medicaid
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
Medicare Part A
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
Medicare Part B
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
POS
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
PPO
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield
Workers Comp
O
37.84
4.74
6.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
EPO
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
HMO
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
Medicaid
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
Medicare Part A
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
Medicare Part B
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
POS
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
PPO
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
blue cross blue shield - medicare advantage
Workers Comp
O
37.84
4.74
8.28
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
EPO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
HMO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
Medicaid
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
Medicare Part A
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
Medicare Part B
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
POS
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
PPO
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
humana - medicare advantage
Workers Comp
O
37.84
4.74
4.74
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
EPO
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
HMO
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
Medicaid
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
Medicare Part A
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
Medicare Part B
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
POS
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
PPO
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
tricare
Workers Comp
O
37.84
4.74
4.76
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
EPO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
HMO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
Medicaid
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
Medicare Part A
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
Medicare Part B
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
POS
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
PPO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
united healthcare
Workers Comp
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
EPO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
HMO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
Medicaid
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
Medicare Part A
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
Medicare Part B
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
POS
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
PPO
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84100
null
cpt
Phosphate level
worker comp
Workers Comp
O
37.84
4.74
27.03
27.03
5.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
EPO
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
HMO
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
Medicaid
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
Medicare Part A
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
Medicare Part B
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
POS
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
PPO
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield
Workers Comp
O
243.07
98.51
151.24
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
EPO
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
HMO
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
Medicaid
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
Medicare Part A
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
Medicare Part B
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
POS
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
PPO
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
blue cross blue shield - medicare advantage
Workers Comp
O
243.07
98.51
204.17
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
EPO
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
HMO
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
Medicaid
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
Medicare Part A
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
Medicare Part B
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
POS
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
PPO
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
tricare
Workers Comp
O
243.07
98.51
98.51
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
EPO
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
HMO
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
Medicaid
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
Medicare Part A
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
Medicare Part B
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
POS
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
PPO
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84112
null
cpt
Cervicovaginal secretion of placenta protein
united healthcare
Workers Comp
O
243.07
98.51
182.30
204.17
52.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
EPO
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
HMO
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
Medicaid
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
Medicare Part A
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
Medicare Part B
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
POS
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
PPO
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna
Workers Comp
O
32.64
3.08
15.64
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
EPO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
HMO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
Medicaid
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
Medicare Part A
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
Medicare Part B
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
POS
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
PPO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
aetna - medicare advantage
Workers Comp
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
EPO
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
HMO
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
Medicaid
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
Medicare Part A
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
Medicare Part B
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
POS
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
PPO
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield
Workers Comp
O
32.64
3.08
11.99
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
EPO
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
HMO
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
Medicaid
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
Medicare Part A
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
Medicare Part B
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
POS
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
PPO
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
blue cross blue shield - medicare advantage
Workers Comp
O
32.64
3.08
10.51
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
EPO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
HMO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
Medicaid
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
Medicare Part A
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
Medicare Part B
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
POS
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
PPO
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
humana - medicare advantage
Workers Comp
O
32.64
3.08
4.76
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
EPO
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
HMO
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
Medicaid
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
Medicare Part A
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
Medicare Part B
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
POS
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
PPO
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
va
Workers Comp
O
32.64
3.08
3.08
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
EPO
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
HMO
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
Medicaid
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
Medicare Part A
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
Medicare Part B
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
POS
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
PPO
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84132
null
cpt
Blood potassium level
webtpa
Workers Comp
O
32.64
3.08
33.28
33.28
5.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
EPO
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
HMO
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
Medicaid
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
Medicare Part A
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
Medicare Part B
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
POS
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
PPO
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84133
null
cpt
Urine potassium level
humana - medicare advantage
Workers Comp
O
36.72
4.73
4.73
4.73
22.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
EPO
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
HMO
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
Medicaid
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
Medicare Part A
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
Medicare Part B
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
POS
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
PPO
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield
Workers Comp
O
69.66
11.87
11.87
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
EPO
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
HMO
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
POS
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
PPO
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
69.66
11.87
12.70
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
EPO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
HMO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
Medicaid
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
Medicare Part A
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
Medicare Part B
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
POS
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
PPO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
humana - medicare advantage
Workers Comp
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
EPO
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
HMO
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
Medicaid
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
Medicare Part A
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
Medicare Part B
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
POS
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
PPO
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
tricare
Workers Comp
O
69.66
11.87
14.65
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
EPO
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
HMO
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
Medicaid
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
Medicare Part A
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
Medicare Part B
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
POS
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
PPO
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
united healthcare
Workers Comp
O
69.66
11.87
49.76
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
EPO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
HMO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
Medicaid
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
Medicare Part A
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
Medicare Part B
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
POS
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
PPO
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84134
null
cpt
Prealbumin (protein) level
va
Workers Comp
O
69.66
11.87
14.59
49.76
17.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
EPO
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
HMO
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
Medicaid
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
Medicare Part A
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
Medicare Part B
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
POS
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
PPO
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
aetna
Workers Comp
O
95.71
16.72
55.51
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
EPO
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
HMO
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
Medicaid
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
Medicare Part A
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
Medicare Part B
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
POS
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
PPO
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield
Workers Comp
O
95.71
16.72
22.22
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
EPO
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
HMO
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
POS
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
PPO
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
16.72
20.80
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
EPO
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
HMO
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
Medicaid
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
Medicare Part A
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
Medicare Part B
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
POS
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
PPO
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
tricare
Workers Comp
O
95.71
16.72
20.95
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
EPO
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
HMO
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
Medicaid
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
Medicare Part A
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
Medicare Part B
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
POS
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
PPO
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
united healthcare
Workers Comp
O
95.71
16.72
68.37
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
EPO
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
HMO
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
Medicaid
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
Medicare Part A
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
Medicare Part B
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
POS
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
PPO
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
va
Workers Comp
O
95.71
16.72
16.72
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
EPO
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
HMO
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
Medicaid
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
Medicare Part A
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
Medicare Part B
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
POS
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
PPO
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84144
null
cpt
Progesterone (reproductive hormone) level
webtpa
Workers Comp
O
95.71
16.72
63.81
68.37
25.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
EPO
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
HMO
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
Medicaid
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
Medicare Part A
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
Medicare Part B
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
POS
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
PPO
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
aetna
Workers Comp
O
92.37
20.21
53.57
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
EPO
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
HMO
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
Medicaid
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
Medicare Part A
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
Medicare Part B
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
POS
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
PPO
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
blue cross blue shield
Workers Comp
O
92.37
20.21
20.21
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
EPO
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
HMO
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
Medicaid
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
Medicare Part A
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
Medicare Part B
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
POS
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
PPO
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
humana - medicare advantage
Workers Comp
O
92.37
20.21
27.22
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
EPO
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
HMO
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
Medicaid
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
Medicare Part A
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
Medicare Part B
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
POS
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
PPO
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84145
null
cpt
Procalcitonin (hormone) level
tricare
Workers Comp
O
92.37
20.21
27.33
53.57
32.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
EPO
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
HMO
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
Medicaid
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
Medicare Part A
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
Medicare Part B
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
POS
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
PPO
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
aetna
Workers Comp
O
109.73
19.38
63.64
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
EPO
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
HMO
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
Medicaid
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
Medicare Part A
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
Medicare Part B
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
POS
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
PPO
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield
Workers Comp
O
109.73
19.38
27.39
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
EPO
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
HMO
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
POS
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
PPO
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
109.73
19.38
23.92
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
EPO
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
HMO
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
Medicaid
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
Medicare Part A
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
Medicare Part B
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
POS
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
PPO
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
cigna
Workers Comp
O
109.73
19.38
77.65
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
EPO
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
HMO
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
Medicaid
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
Medicare Part A
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
Medicare Part B
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
POS
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
PPO
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
healthchoice
Workers Comp
O
109.73
19.38
26.00
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
EPO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
HMO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
Medicaid
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
Medicare Part A
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
Medicare Part B
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
POS
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
PPO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
humana - medicare advantage
Workers Comp
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
EPO
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
HMO
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
Medicaid
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
Medicare Part A
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
Medicare Part B
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
POS
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
PPO
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
tricare
Workers Comp
O
109.73
19.38
19.46
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
EPO
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
HMO
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
Medicaid
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
Medicare Part A
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
Medicare Part B
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
POS
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
PPO
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
united healthcare
Workers Comp
O
109.73
19.38
78.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
EPO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
HMO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
Medicaid
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
Medicare Part A
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
Medicare Part B
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
POS
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
PPO
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84146
null
cpt
Prolactin (milk producing hormone) level
va
Workers Comp
O
109.73
19.38
19.38
78.38
23.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
EPO
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
HMO
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
Medicaid
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
Medicare Part A
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
Medicare Part B
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
POS
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
PPO
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna
Workers Comp
O
86.14
18.39
49.96
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
EPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
HMO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
Medicaid
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
Medicare Part A
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
Medicare Part B
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
POS
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
PPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
aetna - medicare advantage
Workers Comp
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
EPO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
HMO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicaid
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicare Part A
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicare Part B
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
POS
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
PPO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Workers Comp
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
EPO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
HMO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicaid
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicare Part A
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicare Part B
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
POS
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
PPO
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Workers Comp
O
86.14
18.39
21.16
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
EPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
HMO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicaid
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicare Part A
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicare Part B
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
POS
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
PPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Workers Comp
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
EPO
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
HMO
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
Medicaid
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
Medicare Part A
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
Medicare Part B
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
POS
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
PPO
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
tricare
Workers Comp
O
86.14
18.39
18.47
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
EPO
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
HMO
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicaid
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicare Part A
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicare Part B
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
POS
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
PPO
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare
Workers Comp
O
86.14
18.39
61.53
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
EPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
HMO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicaid
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicare Part A
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicare Part B
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
POS
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
PPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Workers Comp
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
EPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
HMO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
Medicaid
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
Medicare Part A
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
Medicare Part B
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
POS
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
PPO
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
va
Workers Comp
O
86.14
18.39
18.39
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
EPO
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
HMO
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
Medicaid
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
Medicare Part A
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
Medicare Part B
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
POS
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
PPO
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84153
null
cpt
PSA (prostate specific antigen)
webtpa
Workers Comp
O
86.14
18.39
60.30
61.53
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
EPO
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
HMO
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
Medicaid
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
Medicare Part A
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
Medicare Part B
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
POS
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
PPO
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
aetna
Workers Comp
O
127.99
18.39
75.51
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
EPO
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
HMO
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicaid
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicare Part A
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Medicare Part B
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
POS
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
PPO
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield
Workers Comp
O
127.99
18.39
19.96
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
EPO
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
HMO
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicaid
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicare Part A
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Medicare Part B
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
POS
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
PPO
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
blue cross blue shield - medicare advantage
Workers Comp
O
127.99
18.39
19.58
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
EPO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
HMO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicaid
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicare Part A
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Medicare Part B
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
POS
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
PPO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
humana - medicare advantage
Workers Comp
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
EPO
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
HMO
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
Medicaid
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
Medicare Part A
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
Medicare Part B
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
POS
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
PPO
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
tricare
Workers Comp
O
127.99
18.39
18.47
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
EPO
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
HMO
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicaid
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicare Part A
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
Medicare Part B
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
POS
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
PPO
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare
Workers Comp
O
127.99
18.39
91.43
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
EPO
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
HMO
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicaid
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicare Part A
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Medicare Part B
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
POS
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
PPO
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
united healthcare - medicare advantage
Workers Comp
O
127.99
18.39
20.08
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
EPO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
HMO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
Medicaid
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
Medicare Part A
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
Medicare Part B
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
POS
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
PPO
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
va
Workers Comp
O
127.99
18.39
18.39
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
EPO
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
HMO
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
Medicaid
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
Medicare Part A
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
Medicare Part B
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
POS
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
PPO
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84154
null
cpt
PSA (prostate specific antigen)
webtpa
Workers Comp
O
127.99
18.39
85.33
91.43
22.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
EPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
HMO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
Medicaid
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
Medicare Part A
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
Medicare Part B
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
POS
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
PPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
aetna
Workers Comp
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
EPO
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
HMO
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
Medicaid
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
Medicare Part A
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
Medicare Part B
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
POS
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
PPO
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield
Workers Comp
O
69.00
3.67
10.47
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
EPO
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
HMO
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
Medicaid
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
Medicare Part A
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
Medicare Part B
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
POS
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
PPO
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
blue cross blue shield - medicare advantage
Workers Comp
O
69.00
3.67
9.62
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
EPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
HMO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
Medicaid
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
Medicare Part A
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
Medicare Part B
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
POS
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
PPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
humana - medicare advantage
Workers Comp
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
EPO
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
HMO
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
Medicaid
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
Medicare Part A
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
Medicare Part B
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
POS
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
PPO
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
tricare
Workers Comp
O
69.00
3.67
3.69
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
EPO
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
HMO
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
Medicaid
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
Medicare Part A
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
Medicare Part B
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
POS
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
PPO
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
united healthcare
Workers Comp
O
69.00
3.67
49.29
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
EPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
HMO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
Medicaid
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
Medicare Part A
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
Medicare Part B
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
POS
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
PPO
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84155
null
cpt
Total protein level blood
va
Workers Comp
O
69.00
3.67
3.67
49.29
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
EPO
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
HMO
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
Medicaid
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
Medicare Part A
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
Medicare Part B
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
POS
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
PPO
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
aetna
Workers Comp
O
76.42
3.67
45.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
EPO
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
HMO
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
Medicaid
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
Medicare Part A
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
Medicare Part B
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
POS
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
PPO
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield
Workers Comp
O
76.42
3.67
11.50
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
EPO
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
HMO
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
Medicaid
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
Medicare Part A
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
Medicare Part B
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
POS
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
PPO
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
blue cross blue shield - medicare advantage
Workers Comp
O
76.42
3.67
11.62
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
EPO
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
HMO
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
Medicaid
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
Medicare Part A
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
Medicare Part B
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
POS
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
PPO
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
cigna
Workers Comp
O
76.42
3.67
52.44
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
EPO
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
HMO
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
Medicaid
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
Medicare Part A
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
Medicare Part B
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
POS
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
PPO
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
healthchoice
Workers Comp
O
76.42
3.67
59.64
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
EPO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
HMO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
Medicaid
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
Medicare Part A
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
Medicare Part B
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
POS
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
PPO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
humana - medicare advantage
Workers Comp
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
EPO
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
HMO
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
Medicaid
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
Medicare Part A
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
Medicare Part B
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
POS
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
PPO
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
medica
Workers Comp
O
76.42
3.67
13.09
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
EPO
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
HMO
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
Medicaid
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
Medicare Part A
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
Medicare Part B
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
POS
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
PPO
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
tricare
Workers Comp
O
76.42
3.67
3.69
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
EPO
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
HMO
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
Medicaid
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
Medicare Part A
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
Medicare Part B
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
POS
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
PPO
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
united healthcare
Workers Comp
O
76.42
3.67
57.31
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
EPO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
HMO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
Medicaid
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
Medicare Part A
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
Medicare Part B
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
POS
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
PPO
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
va
Workers Comp
O
76.42
3.67
3.67
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
EPO
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
HMO
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
Medicaid
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
Medicare Part A
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
Medicare Part B
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
POS
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
PPO
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
webtpa
Workers Comp
O
76.42
3.67
46.11
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
EPO
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
HMO
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
Medicaid
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
Medicare Part A
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
Medicare Part B
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
POS
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
PPO
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84156
null
cpt
Total protein level urine
worker comp
Workers Comp
O
76.42
3.67
25.27
59.64
4.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
EPO
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
HMO
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
Medicaid
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
Medicare Part A
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
Medicare Part B
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
POS
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
PPO
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84157
null
cpt
Total protein level body fluid
humana - medicare advantage
Workers Comp
O
35.38
4.00
4.00
4.00
7.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
EPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
HMO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
Medicaid
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
Medicare Part A
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
Medicare Part B
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
POS
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
PPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
aetna
Workers Comp
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
EPO
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
HMO
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
Medicaid
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
Medicare Part A
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
Medicare Part B
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
POS
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
PPO
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield
Workers Comp
O
110.18
10.74
16.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
EPO
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
HMO
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
Medicaid
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
Medicare Part A
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
Medicare Part B
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
POS
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
PPO
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
blue cross blue shield - medicare advantage
Workers Comp
O
110.18
10.74
15.20
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
EPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
HMO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
Medicaid
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
Medicare Part A
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
Medicare Part B
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
POS
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
PPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
humana - medicare advantage
Workers Comp
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
EPO
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
HMO
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
Medicaid
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
Medicare Part A
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
Medicare Part B
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
POS
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
PPO
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
tricare
Workers Comp
O
110.18
10.74
10.78
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
EPO
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
HMO
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
Medicaid
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
Medicare Part A
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
Medicare Part B
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
POS
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
PPO
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
united healthcare
Workers Comp
O
110.18
10.74
78.71
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
EPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
HMO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
Medicaid
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
Medicare Part A
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
Medicare Part B
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
POS
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
PPO
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84165
null
cpt
Protein measurement serum
va
Workers Comp
O
110.18
10.74
10.74
78.71
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
EPO
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
HMO
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
Medicaid
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
Medicare Part A
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
Medicare Part B
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
POS
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
PPO
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
aetna
Workers Comp
O
57.87
6.87
17.65
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
EPO
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
HMO
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
Medicaid
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
Medicare Part A
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
Medicare Part B
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
POS
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
PPO
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
blue cross blue shield
Workers Comp
O
57.87
6.87
6.87
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
EPO
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
HMO
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
Medicaid
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
Medicare Part A
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
Medicare Part B
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
POS
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
PPO
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
humana - medicare advantage
Workers Comp
O
57.87
6.87
17.83
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
EPO
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
HMO
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
Medicaid
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
Medicare Part A
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
Medicare Part B
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
POS
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
PPO
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
tricare
Workers Comp
O
57.87
6.87
17.90
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
EPO
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
HMO
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
Medicaid
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
Medicare Part A
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
Medicare Part B
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
POS
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
PPO
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84166
null
cpt
Protein measurement body fluid
webtpa
Workers Comp
O
57.87
6.87
18.59
18.59
21.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
EPO
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
HMO
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
Medicaid
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
Medicare Part A
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
Medicare Part B
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
POS
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
PPO
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84182
null
cpt
Protein measurement immunological probe for band identification
blue cross blue shield - medicare advantage
Workers Comp
O
73.03
7.36
7.36
7.36
43.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
EPO
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
HMO
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
Medicaid
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
Medicare Part A
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
Medicare Part B
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
POS
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
PPO
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield
Workers Comp
O
126.88
20.41
22.07
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
EPO
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
HMO
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
Medicaid
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
Medicare Part A
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
Medicare Part B
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
POS
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
PPO
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
blue cross blue shield - medicare advantage
Workers Comp
O
126.88
20.41
20.41
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
EPO
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
HMO
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
Medicaid
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
Medicare Part A
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
Medicare Part B
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
POS
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
PPO
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
humana - medicare advantage
Workers Comp
O
126.88
20.41
28.10
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
EPO
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
HMO
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
Medicaid
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
Medicare Part A
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
Medicare Part B
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
POS
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
PPO
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84207
null
cpt
Vitamin B-6 level
tricare
Workers Comp
O
126.88
20.41
28.22
28.22
76.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
EPO
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
HMO
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
Medicaid
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
Medicare Part A
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
Medicare Part B
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
POS
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
PPO
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84210
null
cpt
Pyruvate (organic acid) level
blue cross blue shield
Workers Comp
O
36.20
15.55
15.55
15.55
21.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
EPO
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
HMO
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
Medicaid
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
Medicare Part A
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
Medicare Part B
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
POS
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
PPO
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84238
null
cpt
Chemical receptor analysis
blue cross blue shield
Workers Comp
O
91.43
60.61
60.61
60.61
54.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
EPO
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
HMO
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
Medicaid
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
Medicare Part A
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
Medicare Part B
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
POS
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
PPO
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
blue cross blue shield
Workers Comp
O
145.10
21.99
23.95
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
EPO
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
HMO
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
Medicaid
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
Medicare Part A
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
Medicare Part B
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
POS
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
PPO
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
humana - medicare advantage
Workers Comp
O
145.10
21.99
21.99
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
EPO
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
HMO
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
Medicaid
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
Medicare Part A
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
Medicare Part B
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
POS
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
PPO
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84244
null
cpt
Renin (kidney enzyme) level
united healthcare
Workers Comp
O
145.10
21.99
97.79
97.79
87.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
EPO
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
HMO
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
Medicaid
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
Medicare Part A
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
Medicare Part B
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
POS
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
PPO
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84260
null
cpt
Serotonin (hormone) level
tricare
Workers Comp
O
221.48
31.11
31.11
31.11
132.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
EPO
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
HMO
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
Medicaid
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
Medicare Part A
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
Medicare Part B
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
POS
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
PPO
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield
Workers Comp
O
54.33
8.74
8.74
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
EPO
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
HMO
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
POS
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
PPO
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
54.33
8.74
34.12
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
EPO
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
HMO
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
Medicaid
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
Medicare Part A
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
Medicare Part B
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
POS
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
PPO
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84270
null
cpt
Sex hormone binding globulin (protein) level
tricare
Workers Comp
O
54.33
8.74
21.82
34.12
32.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
EPO
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
HMO
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
Medicaid
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
Medicare Part A
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
Medicare Part B
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
POS
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
PPO
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
humana - medicare advantage
Workers Comp
O
33.70
3.22
4.81
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
EPO
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
HMO
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
Medicaid
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
Medicare Part A
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
Medicare Part B
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
POS
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
PPO
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84295
null
cpt
Blood sodium level
va
Workers Comp
O
33.70
3.22
3.22
4.81
20.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
EPO
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
HMO
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
Medicaid
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
Medicare Part A
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
Medicare Part B
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
POS
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
PPO
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
blue cross blue shield
Workers Comp
O
35.38
3.72
3.72
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
EPO
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
HMO
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
Medicaid
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
Medicare Part A
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
Medicare Part B
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
POS
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
PPO
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84300
null
cpt
Urine sodium level
humana - medicare advantage
Workers Comp
O
35.38
3.72
5.06
5.06
21.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
EPO
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
HMO
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
Medicaid
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
Medicare Part A
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
Medicare Part B
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
POS
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
PPO
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
blue cross blue shield
Workers Comp
O
241.52
21.35
33.70
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
EPO
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
HMO
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
Medicaid
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
Medicare Part A
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
Medicare Part B
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
POS
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
PPO
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84305
null
cpt
Somatomedin (growth factor) level
tricare
Workers Comp
O
241.52
21.35
21.35
33.70
144.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
EPO
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
HMO
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
Medicaid
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
Medicare Part A
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
Medicare Part B
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
POS
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
PPO
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84307
null
cpt
Somatostatin (growth hormone inhibitor) level
blue cross blue shield
Workers Comp
O
45.70
13.03
13.03
13.03
27.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
EPO
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
HMO
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
Medicaid
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
Medicare Part A
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
Medicare Part B
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
POS
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
PPO
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
aetna
Workers Comp
O
20.25
8.10
52.50
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
EPO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
HMO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
Medicaid
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
Medicare Part A
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
Medicare Part B
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
POS
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
PPO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
humana - medicare advantage
Workers Comp
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
EPO
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
HMO
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
Medicaid
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
Medicare Part A
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
Medicare Part B
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
POS
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
PPO
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
tricare
Workers Comp
O
20.25
8.10
8.13
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
EPO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
HMO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
Medicaid
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
Medicare Part A
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
Medicare Part B
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
POS
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
PPO
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84311
null
cpt
Chemical analysis using spectrophotometry (light)
va
Workers Comp
O
20.25
8.10
8.10
52.50
9.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
EPO
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
HMO
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
Medicaid
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
Medicare Part A
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
Medicare Part B
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
POS
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
PPO
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84376
null
cpt
Carbohydrate analysis single qualitative
humana - medicare advantage
Workers Comp
O
21.34
5.50
5.50
5.50
12.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
EPO
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
HMO
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
Medicaid
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
Medicare Part A
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
Medicare Part B
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
POS
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
PPO
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
aetna
Workers Comp
O
66.78
13.87
38.73
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
EPO
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
HMO
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
Medicaid
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
Medicare Part A
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
Medicare Part B
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
POS
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
PPO
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield
Workers Comp
O
66.78
13.87
14.27
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
EPO
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
HMO
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
Medicaid
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
Medicare Part A
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
Medicare Part B
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
POS
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
PPO
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
blue cross blue shield - medicare advantage
Workers Comp
O
66.78
13.87
13.87
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
EPO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
HMO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
Medicaid
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
Medicare Part A
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
Medicare Part B
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
POS
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
PPO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
humana - medicare advantage
Workers Comp
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
EPO
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
HMO
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
Medicaid
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
Medicare Part A
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
Medicare Part B
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
POS
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
PPO
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
tricare
Workers Comp
O
66.78
13.87
25.57
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
EPO
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
HMO
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
Medicaid
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
Medicare Part A
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
Medicare Part B
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
POS
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
PPO
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
united healthcare
Workers Comp
O
66.78
13.87
47.70
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
EPO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
HMO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
Medicaid
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
Medicare Part A
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
Medicare Part B
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
POS
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
PPO
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
va
Workers Comp
O
66.78
13.87
25.47
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
EPO
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
HMO
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
Medicaid
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
Medicare Part A
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
Medicare Part B
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
POS
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
PPO
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84402
null
cpt
Testosterone (hormone) level free
webtpa
Workers Comp
O
66.78
13.87
46.75
47.70
30.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
EPO
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
HMO
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
Medicaid
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
Medicare Part A
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
Medicare Part B
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
POS
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
PPO
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna
Workers Comp
O
127.99
25.81
74.23
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
EPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
HMO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
Medicaid
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
Medicare Part A
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
Medicare Part B
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
POS
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
PPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
aetna - medicare advantage
Workers Comp
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
EPO
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
HMO
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
Medicaid
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
Medicare Part A
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
Medicare Part B
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
POS
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
PPO
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield
Workers Comp
O
127.99
25.81
30.78
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
EPO
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
HMO
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
Medicaid
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
Medicare Part A
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
Medicare Part B
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
POS
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
PPO
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
blue cross blue shield - medicare advantage
Workers Comp
O
127.99
25.81
29.44
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
EPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
HMO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
Medicaid
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
Medicare Part A
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
Medicare Part B
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
POS
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
PPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
humana - medicare advantage
Workers Comp
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
EPO
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
HMO
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
Medicaid
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
Medicare Part A
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
Medicare Part B
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
POS
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
PPO
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
tricare
Workers Comp
O
127.99
25.81
25.92
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
EPO
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
HMO
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
Medicaid
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
Medicare Part A
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
Medicare Part B
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
POS
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
PPO
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
united healthcare
Workers Comp
O
127.99
25.81
91.43
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
EPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
HMO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
Medicaid
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
Medicare Part A
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
Medicare Part B
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
POS
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
PPO
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
va
Workers Comp
O
127.99
25.81
25.81
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
EPO
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
HMO
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
Medicaid
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
Medicare Part A
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
Medicare Part B
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
POS
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
PPO
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84403
null
cpt
Testosterone (hormone) level total
webtpa
Workers Comp
O
127.99
25.81
85.33
91.43
30.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
EPO
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
HMO
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
Medicaid
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
Medicare Part A
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
Medicare Part B
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
POS
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
PPO
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
aetna
Workers Comp
O
130.22
20.89
75.53
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
EPO
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
HMO
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
Medicaid
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
Medicare Part A
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
Medicare Part B
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
POS
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
PPO
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield
Workers Comp
O
130.22
20.89
23.16
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
EPO
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
HMO
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
Medicaid
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
Medicare Part A
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
Medicare Part B
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
POS
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
PPO
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
blue cross blue shield - medicare advantage
Workers Comp
O
130.22
20.89
20.89
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
EPO
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
HMO
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
Medicaid
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
Medicare Part A
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
Medicare Part B
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
POS
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
PPO
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84425
null
cpt
Vitamin B-1 (thiamine) level
humana - medicare advantage
Workers Comp
O
130.22
20.89
21.23
75.53
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
EPO
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
HMO
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
Medicaid
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
Medicare Part A
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
Medicare Part B
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
POS
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
PPO
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield
Workers Comp
O
87.92
16.06
21.32
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
EPO
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
HMO
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
POS
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
PPO
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
16.06
43.82
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
EPO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
HMO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
Medicaid
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
Medicare Part A
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
Medicare Part B
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
POS
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
PPO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
humana - medicare advantage
Workers Comp
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
EPO
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
HMO
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
Medicaid
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
Medicare Part A
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
Medicare Part B
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
POS
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
PPO
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
tricare
Workers Comp
O
87.92
16.06
17.02
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
EPO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
HMO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
Medicaid
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
Medicare Part A
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
Medicare Part B
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
POS
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
PPO
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
va
Workers Comp
O
87.92
16.06
16.06
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
EPO
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
HMO
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
Medicaid
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
Medicare Part A
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
Medicare Part B
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
POS
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
PPO
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84432
null
cpt
Thyroglobulin (thyroid related hormone) level
webtpa
Workers Comp
O
87.92
16.06
53.36
53.36
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
EPO
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
HMO
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
Medicaid
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
Medicare Part A
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
Medicare Part B
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
POS
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
PPO
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
aetna
Workers Comp
O
53.95
4.60
31.83
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
EPO
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
HMO
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
Medicaid
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
Medicare Part A
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
Medicare Part B
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
POS
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
PPO
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield
Workers Comp
O
53.95
4.60
20.69
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
EPO
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
HMO
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
Medicaid
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
Medicare Part A
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
Medicare Part B
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
POS
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
PPO
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
blue cross blue shield - medicare advantage
Workers Comp
O
53.95
4.60
16.04
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
EPO
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
HMO
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
Medicaid
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
Medicare Part A
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
Medicare Part B
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
POS
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
PPO
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
humana - medicare advantage
Workers Comp
O
53.95
4.60
6.87
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
EPO
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
HMO
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
Medicaid
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
Medicare Part A
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
Medicare Part B
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
POS
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
PPO
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
united healthcare
Workers Comp
O
53.95
4.60
40.46
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
EPO
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
HMO
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
Medicaid
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
Medicare Part A
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
Medicare Part B
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
POS
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
PPO
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84436
null
cpt
Thyroxine (thyroid chemical) total
va
Workers Comp
O
53.95
4.60
4.60
40.46
8.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
EPO
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
HMO
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
Medicaid
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
Medicare Part A
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
Medicare Part B
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
POS
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
PPO
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna
Workers Comp
O
49.63
6.04
28.79
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
EPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
HMO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
Medicaid
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
Medicare Part A
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
Medicare Part B
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
POS
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
PPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
aetna - medicare advantage
Workers Comp
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
EPO
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
HMO
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
Medicaid
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
Medicare Part A
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
Medicare Part B
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
POS
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
PPO
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield
Workers Comp
O
49.63
6.04
10.10
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
EPO
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
HMO
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
Medicaid
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
Medicare Part A
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
Medicare Part B
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
POS
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
PPO
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
blue cross blue shield - medicare advantage
Workers Comp
O
49.63
6.04
9.33
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
EPO
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
HMO
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
Medicaid
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
Medicare Part A
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
Medicare Part B
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
POS
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
PPO
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
cigna
Workers Comp
O
49.63
6.04
35.12
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
EPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
HMO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
Medicaid
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
Medicare Part A
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
Medicare Part B
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
POS
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
PPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
geha
Workers Comp
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
EPO
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
HMO
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
Medicaid
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
Medicare Part A
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
Medicare Part B
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
POS
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
PPO
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
healthchoice
Workers Comp
O
49.63
6.04
11.76
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
EPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
HMO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
Medicaid
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
Medicare Part A
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
Medicare Part B
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
POS
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
PPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana
Workers Comp
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
EPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
HMO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
Medicaid
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
Medicare Part A
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
Medicare Part B
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
POS
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
PPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
humana - medicare advantage
Workers Comp
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
EPO
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
HMO
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
Medicaid
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
Medicare Part A
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
Medicare Part B
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
POS
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
PPO
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
medica
Workers Comp
O
49.63
6.04
18.36
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
EPO
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
HMO
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
Medicaid
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
Medicare Part A
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
Medicare Part B
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
POS
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
PPO
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
tricare
Workers Comp
O
49.63
6.04
9.06
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
EPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
HMO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
Medicaid
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
Medicare Part A
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
Medicare Part B
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
POS
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
PPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare
Workers Comp
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
EPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
HMO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
Medicaid
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
Medicare Part A
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
Medicare Part B
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
POS
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
PPO
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
united healthcare - medicare advantage
Workers Comp
O
49.63
6.04
9.02
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
EPO
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
HMO
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
Medicaid
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
Medicare Part A
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
Medicare Part B
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
POS
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
PPO
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
va
Workers Comp
O
49.63
6.04
6.04
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
EPO
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
HMO
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
Medicaid
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
Medicare Part A
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
Medicare Part B
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
POS
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
PPO
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
webtpa
Workers Comp
O
49.63
6.04
33.09
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
EPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
HMO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
Medicaid
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
Medicare Part A
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
Medicare Part B
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
POS
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
PPO
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84439
null
cpt
Thyroxine (thyroid chemical) free
worker comp
Workers Comp
O
49.63
6.04
35.45
35.45
10.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
EPO
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
HMO
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
Medicaid
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
Medicare Part A
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
Medicare Part B
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
POS
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
PPO
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna
Workers Comp
O
113.52
16.80
65.84
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
EPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
HMO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
Medicaid
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
Medicare Part A
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
Medicare Part B
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
POS
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
PPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
aetna - medicare advantage
Workers Comp
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
EPO
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
HMO
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
Medicaid
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
Medicare Part A
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
Medicare Part B
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
POS
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
PPO
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield
Workers Comp
O
113.52
16.80
23.49
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
EPO
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
HMO
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
Medicaid
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
Medicare Part A
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
Medicare Part B
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
POS
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
PPO
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
blue cross blue shield - medicare advantage
Workers Comp
O
113.52
16.80
24.51
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
EPO
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
HMO
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
Medicaid
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
Medicare Part A
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
Medicare Part B
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
POS
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
PPO
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
cigna
Workers Comp
O
113.52
16.80
80.33
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
EPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
HMO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
Medicaid
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
Medicare Part A
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
Medicare Part B
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
POS
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
PPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
geha
Workers Comp
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
EPO
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
HMO
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
Medicaid
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
Medicare Part A
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
Medicare Part B
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
POS
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
PPO
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
healthchoice
Workers Comp
O
113.52
16.80
25.01
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
EPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
HMO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
Medicaid
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
Medicare Part A
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
Medicare Part B
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
POS
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
PPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana
Workers Comp
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
EPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
HMO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
Medicaid
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
Medicare Part A
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
Medicare Part B
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
POS
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
PPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
humana - medicare advantage
Workers Comp
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
EPO
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
HMO
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
Medicaid
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
Medicare Part A
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
Medicare Part B
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
POS
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
PPO
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
medica
Workers Comp
O
113.52
16.80
42.00
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
EPO
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
HMO
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
Medicaid
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
Medicare Part A
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
Medicare Part B
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
POS
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
PPO
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
tricare
Workers Comp
O
113.52
16.80
16.87
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
EPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
HMO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
Medicaid
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
Medicare Part A
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
Medicare Part B
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
POS
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
PPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare
Workers Comp
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
EPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
HMO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
Medicaid
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
Medicare Part A
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
Medicare Part B
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
POS
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
PPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
united healthcare - medicare advantage
Workers Comp
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
EPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
HMO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
Medicaid
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
Medicare Part A
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
Medicare Part B
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
POS
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
PPO
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
va
Workers Comp
O
113.52
16.80
16.80
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
EPO
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
HMO
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
Medicaid
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
Medicare Part A
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
Medicare Part B
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
POS
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
PPO
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
webtpa
Workers Comp
O
113.52
16.80
75.68
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
EPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
HMO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
Medicaid
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
Medicare Part A
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
Medicare Part B
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
POS
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
PPO
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84443
null
cpt
Blood test thyroid stimulating hormone (TSH)
worker comp
Workers Comp
O
113.52
16.80
81.09
81.09
20.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
EPO
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
HMO
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
Medicaid
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
Medicare Part A
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
Medicare Part B
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
POS
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
PPO
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield
Workers Comp
O
127.99
28.77
28.77
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
EPO
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
HMO
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
Medicaid
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
POS
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
PPO
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
127.99
28.77
32.58
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
EPO
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
HMO
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
Medicaid
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
Medicare Part A
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
Medicare Part B
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
POS
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
PPO
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
humana - medicare advantage
Workers Comp
O
127.99
28.77
50.86
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
EPO
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
HMO
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
Medicaid
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
Medicare Part A
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
Medicare Part B
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
POS
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
PPO
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84445
null
cpt
Thyroid stimulating immune globulins (thyroid related protein) level
tricare
Workers Comp
O
127.99
28.77
51.07
51.07
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
EPO
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
HMO
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
Medicaid
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
Medicare Part A
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
Medicare Part B
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
POS
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
PPO
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield
Workers Comp
O
79.02
12.74
12.80
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
EPO
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
HMO
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
Medicaid
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
Medicare Part A
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
Medicare Part B
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
POS
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
PPO
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
blue cross blue shield - medicare advantage
Workers Comp
O
79.02
12.74
12.74
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
EPO
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
HMO
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
Medicaid
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
Medicare Part A
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
Medicare Part B
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
POS
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
PPO
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84446
null
cpt
Vitamin E level
humana - medicare advantage
Workers Comp
O
79.02
12.74
14.18
14.18
47.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
EPO
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
HMO
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
Medicaid
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
Medicare Part A
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
Medicare Part B
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
POS
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
PPO
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield
Workers Comp
O
29.48
3.19
4.31
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
EPO
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
HMO
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
Medicaid
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
Medicare Part A
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
Medicare Part B
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
POS
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
PPO
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
blue cross blue shield - medicare advantage
Workers Comp
O
29.48
3.19
3.98
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
EPO
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
HMO
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
Medicaid
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
Medicare Part A
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
Medicare Part B
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
POS
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
PPO
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
humana - medicare advantage
Workers Comp
O
29.48
3.19
5.30
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
EPO
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
HMO
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
Medicaid
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
Medicare Part A
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
Medicare Part B
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
POS
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
PPO
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
tricare
Workers Comp
O
29.48
3.19
5.32
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
EPO
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
HMO
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
Medicaid
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
Medicare Part A
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
Medicare Part B
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
POS
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
PPO
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84460
null
cpt
Liver enzyme (SGPT) level
va
Workers Comp
O
29.48
3.19
3.19
5.32
6.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
EPO
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
HMO
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
Medicaid
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
Medicare Part A
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
Medicare Part B
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
POS
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
PPO
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
aetna
Workers Comp
O
63.44
9.59
36.80
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
EPO
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
HMO
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
Medicaid
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
Medicare Part A
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
Medicare Part B
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
POS
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
PPO
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield
Workers Comp
O
63.44
9.59
9.59
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
EPO
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
HMO
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
Medicaid
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
POS
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
PPO
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
63.44
9.59
10.83
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
EPO
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
HMO
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
Medicaid
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
Medicare Part A
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
Medicare Part B
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
POS
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
PPO
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84466
null
cpt
Transferrin (iron binding protein) level
tricare
Workers Comp
O
63.44
9.59
12.81
36.80
38.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
EPO
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
HMO
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
Medicaid
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
Medicare Part A
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
Medicare Part B
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
POS
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
PPO
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
blue cross blue shield
Workers Comp
O
58.98
5.74
8.51
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
EPO
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
HMO
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
Medicaid
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
Medicare Part A
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
Medicare Part B
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
POS
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
PPO
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84478
null
cpt
Triglycerides level
humana - medicare advantage
Workers Comp
O
58.98
5.74
5.74
8.51
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
EPO
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
HMO
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
Medicaid
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
Medicare Part A
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
Medicare Part B
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
POS
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
PPO
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84479
null
cpt
Thyroid hormone evaluation
humana - medicare advantage
Workers Comp
O
65.66
6.47
6.47
6.47
39.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
EPO
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
HMO
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
Medicaid
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
Medicare Part A
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
Medicare Part B
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
POS
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
PPO
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna
Workers Comp
O
56.64
14.18
31.83
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
EPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
HMO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
Medicaid
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
Medicare Part A
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
Medicare Part B
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
POS
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
PPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
aetna - medicare advantage
Workers Comp
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
EPO
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
HMO
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
Medicaid
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
Medicare Part A
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
Medicare Part B
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
POS
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
PPO
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield
Workers Comp
O
56.64
14.18
14.37
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
EPO
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
HMO
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
Medicaid
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
Medicare Part A
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
Medicare Part B
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
POS
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
PPO
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
blue cross blue shield - medicare advantage
Workers Comp
O
56.64
14.18
16.63
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
EPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
HMO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
Medicaid
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
Medicare Part A
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
Medicare Part B
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
POS
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
PPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
humana - medicare advantage
Workers Comp
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
EPO
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
HMO
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
Medicaid
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
Medicare Part A
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
Medicare Part B
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
POS
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
PPO
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
tricare
Workers Comp
O
56.64
14.18
15.03
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
EPO
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
HMO
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
Medicaid
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
Medicare Part A
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
Medicare Part B
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
POS
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
PPO
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare
Workers Comp
O
56.64
14.18
40.46
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
EPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
HMO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
Medicaid
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
Medicare Part A
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
Medicare Part B
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
POS
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
PPO
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
united healthcare - medicare advantage
Workers Comp
O
56.64
14.18
14.18
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
EPO
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
HMO
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
Medicaid
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
Medicare Part A
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
Medicare Part B
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
POS
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
PPO
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84480
null
cpt
Thyroid hormone T3 measurement total
webtpa
Workers Comp
O
56.64
14.18
37.77
40.46
17.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
EPO
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
HMO
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
Medicaid
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
Medicare Part A
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
Medicare Part B
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
POS
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
PPO
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
aetna
Workers Comp
O
102.72
11.34
59.58
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
EPO
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
HMO
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
Medicaid
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
Medicare Part A
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
Medicare Part B
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
POS
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
PPO
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield
Workers Comp
O
102.72
11.34
23.89
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
EPO
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
HMO
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
Medicaid
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
Medicare Part A
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
Medicare Part B
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
POS
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
PPO
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
blue cross blue shield - medicare advantage
Workers Comp
O
102.72
11.34
26.39
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
EPO
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
HMO
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
Medicaid
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
Medicare Part A
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
Medicare Part B
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
POS
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
PPO
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
humana - medicare advantage
Workers Comp
O
102.72
11.34
16.94
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
EPO
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
HMO
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
Medicaid
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
Medicare Part A
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
Medicare Part B
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
POS
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
PPO
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
tricare
Workers Comp
O
102.72
11.34
17.01
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
EPO
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
HMO
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
Medicaid
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
Medicare Part A
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
Medicare Part B
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
POS
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
PPO
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
united healthcare
Workers Comp
O
102.72
11.34
73.37
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
EPO
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
HMO
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
Medicaid
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
Medicare Part A
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
Medicare Part B
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
POS
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
PPO
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
va
Workers Comp
O
102.72
11.34
11.34
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
EPO
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
HMO
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
Medicaid
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
Medicare Part A
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
Medicare Part B
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
POS
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
PPO
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
webtpa
Workers Comp
O
102.72
11.34
70.19
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
EPO
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
HMO
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
Medicaid
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
Medicare Part A
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
Medicare Part B
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
POS
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
PPO
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84481
null
cpt
Thyroid hormone T3 measurement free
worker comp
Workers Comp
O
102.72
11.34
45.68
73.37
20.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
EPO
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
HMO
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
Medicaid
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
Medicare Part A
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
Medicare Part B
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
POS
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
PPO
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84482
null
cpt
Thyroid hormone T3 measurement reverse
blue cross blue shield
Workers Comp
O
81.24
15.09
15.09
15.09
48.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
EPO
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
HMO
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
Medicaid
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
Medicare Part A
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
Medicare Part B
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
POS
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
PPO
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna
Workers Comp
O
75.56
11.80
46.45
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
EPO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
HMO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
Medicaid
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
Medicare Part A
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
Medicare Part B
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
POS
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
PPO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
aetna - medicare advantage
Workers Comp
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
EPO
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
HMO
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
Medicaid
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
Medicare Part A
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
Medicare Part B
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
POS
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
PPO
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield
Workers Comp
O
75.56
11.80
15.33
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
EPO
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
HMO
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
Medicaid
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
Medicare Part A
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
Medicare Part B
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
POS
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
PPO
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
blue cross blue shield - medicare advantage
Workers Comp
O
75.56
11.80
11.80
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
EPO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
HMO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
Medicaid
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
Medicare Part A
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
Medicare Part B
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
POS
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
PPO
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
humana - medicare advantage
Workers Comp
O
75.56
11.80
12.47
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
EPO
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
HMO
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
Medicaid
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
Medicare Part A
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
Medicare Part B
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
POS
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
PPO
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84484
null
cpt
Troponin (protein) analysis quantitative
united healthcare
Workers Comp
O
75.56
11.80
124.79
124.79
14.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
EPO
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
HMO
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
Medicaid
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
Medicare Part A
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
Medicare Part B
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
POS
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
PPO
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield
Workers Comp
O
37.84
2.65
8.68
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
EPO
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
HMO
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
Medicaid
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
Medicare Part A
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
Medicare Part B
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
POS
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
PPO
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
blue cross blue shield - medicare advantage
Workers Comp
O
37.84
2.65
8.03
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
EPO
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
HMO
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
Medicaid
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
Medicare Part A
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
Medicare Part B
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
POS
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
PPO
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
humana - medicare advantage
Workers Comp
O
37.84
2.65
3.95
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
EPO
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
HMO
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
Medicaid
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
Medicare Part A
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
Medicare Part B
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
POS
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
PPO
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84520
null
cpt
Urea nitrogen level to assess kidney function quantitative
va
Workers Comp
O
37.84
2.65
2.65
8.68
4.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
EPO
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
HMO
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
Medicaid
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
Medicare Part A
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
Medicare Part B
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
POS
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
PPO
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna
Workers Comp
O
47.18
3.02
27.36
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
EPO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
HMO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
Medicaid
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
Medicare Part A
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
Medicare Part B
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
POS
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
PPO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
aetna - medicare advantage
Workers Comp
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
EPO
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
HMO
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
Medicaid
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
Medicare Part A
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
Medicare Part B
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
POS
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
PPO
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield
Workers Comp
O
47.18
3.02
9.33
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
EPO
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
HMO
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
Medicaid
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
Medicare Part A
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
Medicare Part B
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
POS
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
PPO
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
blue cross blue shield - medicare advantage
Workers Comp
O
47.18
3.02
9.31
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
EPO
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
HMO
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
Medicaid
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
Medicare Part A
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
Medicare Part B
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
POS
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
PPO
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
cigna
Workers Comp
O
47.18
3.02
78.70
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
EPO
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
HMO
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
Medicaid
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
Medicare Part A
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
Medicare Part B
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
POS
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
PPO
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
healthchoice
Workers Comp
O
47.18
3.02
89.51
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
EPO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
HMO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
Medicaid
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
Medicare Part A
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
Medicare Part B
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
POS
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
PPO
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
humana - medicare advantage
Workers Comp
O
47.18
3.02
4.52
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
EPO
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
HMO
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
Medicaid
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
Medicare Part A
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
Medicare Part B
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
POS
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
PPO
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
medica
Workers Comp
O
47.18
3.02
17.46
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
EPO
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
HMO
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
Medicaid
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
Medicare Part A
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
Medicare Part B
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
POS
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
PPO
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
tricare
Workers Comp
O
47.18
3.02
4.54
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
EPO
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
HMO
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
Medicaid
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
Medicare Part A
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
Medicare Part B
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
POS
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
PPO
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare
Workers Comp
O
47.18
3.02
34.55
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
EPO
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
HMO
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
Medicaid
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
Medicare Part A
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
Medicare Part B
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
POS
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
PPO
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
united healthcare - medicare advantage
Workers Comp
O
47.18
3.02
4.43
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
EPO
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
HMO
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
Medicaid
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
Medicare Part A
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
Medicare Part B
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
POS
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
PPO
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
va
Workers Comp
O
47.18
3.02
3.02
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
EPO
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
HMO
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
Medicaid
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
Medicare Part A
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
Medicare Part B
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
POS
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
PPO
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
webtpa
Workers Comp
O
47.18
3.02
32.25
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
EPO
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
HMO
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
Medicaid
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
Medicare Part A
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
Medicare Part B
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
POS
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
PPO
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84550
null
cpt
Uric acid level blood
worker comp
Workers Comp
O
47.18
3.02
33.71
89.51
5.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
EPO
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
HMO
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
Medicaid
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
Medicare Part A
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
Medicare Part B
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
POS
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
PPO
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84560
null
cpt
Uric acid level
humana - medicare advantage
Workers Comp
O
127.99
5.08
5.08
5.08
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
EPO
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
HMO
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
Medicaid
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
Medicare Part A
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
Medicare Part B
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
POS
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
PPO
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84585
null
cpt
Urine vanillylmandelic acid
blue cross blue shield - medicare advantage
Workers Comp
O
140.23
59.38
59.38
59.38
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
EPO
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
HMO
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
Medicaid
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
Medicare Part A
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
Medicare Part B
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
POS
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
PPO
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
blue cross blue shield
Workers Comp
O
88.33
19.44
19.44
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
EPO
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
HMO
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
Medicaid
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
Medicare Part A
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
Medicare Part B
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
POS
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
PPO
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84586
null
cpt
Vasoactive intestinal peptide (intestinal hormone) level
humana - medicare advantage
Workers Comp
O
88.33
19.44
35.33
35.33
53.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
EPO
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
HMO
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
Medicaid
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
POS
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
PPO
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84591
null
cpt
Vitamin measurement
blue cross blue shield - medicare advantage
Workers Comp
O
42.65
6.57
6.57
6.57
25.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
EPO
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
HMO
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
Medicaid
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
Medicare Part A
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
Medicare Part B
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
POS
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
PPO
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
846
null
ms-drg
chemotherapy without acute leukemia as secondary diagnosis with mcc
tricare
Workers Comp
I
39715.72
17225.19
17225.19
17225.19
23829.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
EPO
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
HMO
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
Medicaid
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
Medicare Part A
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
Medicare Part B
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
POS
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
PPO
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield
Workers Comp
O
72.34
10.07
15.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
EPO
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
HMO
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
Medicaid
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
Medicare Part A
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
Medicare Part B
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
POS
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
PPO
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
blue cross blue shield - medicare advantage
Workers Comp
O
72.34
10.07
10.07
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
EPO
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
HMO
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
Medicaid
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
Medicare Part A
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
Medicare Part B
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
POS
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
PPO
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
humana - medicare advantage
Workers Comp
O
72.34
10.07
11.39
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
EPO
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
HMO
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
Medicaid
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
Medicare Part A
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
Medicare Part B
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
POS
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
PPO
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84630
null
cpt
Zinc level
tricare
Workers Comp
O
72.34
10.07
11.44
15.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
EPO
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
HMO
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
Medicaid
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
Medicare Part A
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
Medicare Part B
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
POS
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
PPO
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
aetna
Workers Comp
O
87.92
13.66
49.41
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
EPO
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
HMO
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
Medicaid
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
Medicare Part A
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
Medicare Part B
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
POS
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
PPO
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield
Workers Comp
O
87.92
13.66
14.13
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
EPO
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
HMO
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
Medicaid
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
POS
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
PPO
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
13.66
13.66
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
EPO
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
HMO
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
Medicaid
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
Medicare Part A
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
Medicare Part B
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
POS
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
PPO
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
humana - medicare advantage
Workers Comp
O
87.92
13.66
20.81
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
EPO
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
HMO
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
Medicaid
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
Medicare Part A
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
Medicare Part B
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
POS
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
PPO
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84681
null
cpt
C-peptide (protein) level
tricare
Workers Comp
O
87.92
13.66
20.90
49.41
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
EPO
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
HMO
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
Medicaid
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
Medicare Part A
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
Medicare Part B
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
POS
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
PPO
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
aetna
Workers Comp
O
63.44
15.05
36.80
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
EPO
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
HMO
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
Medicaid
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
Medicare Part A
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
Medicare Part B
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
POS
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
PPO
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield
Workers Comp
O
63.44
15.05
31.75
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
EPO
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
HMO
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicaid
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part A
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
Medicare Part B
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
POS
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
PPO
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
blue cross blue shield - medicare advantage
Workers Comp
O
63.44
15.05
23.24
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
EPO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
HMO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
Medicaid
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
Medicare Part A
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
Medicare Part B
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
POS
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
PPO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
humana - medicare advantage
Workers Comp
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
EPO
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
HMO
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
Medicaid
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
Medicare Part A
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
Medicare Part B
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
POS
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
PPO
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
tricare
Workers Comp
O
63.44
15.05
15.11
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
EPO
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
HMO
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
Medicaid
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
Medicare Part A
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
Medicare Part B
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
POS
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
PPO
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
united healthcare
Workers Comp
O
63.44
15.05
45.32
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
EPO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
HMO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
Medicaid
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
Medicare Part A
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
Medicare Part B
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
POS
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
PPO
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
va
Workers Comp
O
63.44
15.05
15.05
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
EPO
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
HMO
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
Medicaid
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
Medicare Part A
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
Medicare Part B
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
POS
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
PPO
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84702
null
cpt
Gonadotropin chorionic (reproductive hormone) level
webtpa
Workers Comp
O
63.44
15.05
42.29
45.32
45.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
EPO
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
HMO
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
Medicaid
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
Medicare Part A
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
Medicare Part B
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
POS
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
PPO
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
aetna
Workers Comp
O
58.98
7.52
34.80
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
EPO
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
HMO
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
Medicaid
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
Medicare Part A
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
Medicare Part B
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
POS
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
PPO
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield
Workers Comp
O
58.98
7.52
21.91
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
EPO
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
HMO
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
Medicaid
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
Medicare Part A
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
Medicare Part B
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
POS
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
PPO
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
blue cross blue shield - medicare advantage
Workers Comp
O
58.98
7.52
20.34
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
EPO
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
HMO
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
Medicaid
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
Medicare Part A
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
Medicare Part B
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
POS
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
PPO
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
cigna
Workers Comp
O
58.98
7.52
38.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
EPO
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
HMO
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
Medicaid
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
Medicare Part A
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
Medicare Part B
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
POS
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
PPO
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
healthchoice
Workers Comp
O
58.98
7.52
28.76
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
EPO
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
HMO
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
Medicaid
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
Medicare Part A
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
Medicare Part B
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
POS
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
PPO
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
humana - medicare advantage
Workers Comp
O
58.98
7.52
7.52
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
EPO
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
HMO
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
Medicaid
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
Medicare Part A
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
Medicare Part B
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
POS
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
PPO
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
tricare
Workers Comp
O
58.98
7.52
7.55
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
EPO
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
HMO
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
Medicaid
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
Medicare Part A
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
Medicare Part B
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
POS
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
PPO
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
united healthcare
Workers Comp
O
58.98
7.52
42.14
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
EPO
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
HMO
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
Medicaid
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
Medicare Part A
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
Medicare Part B
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
POS
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
PPO
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
va
Workers Comp
O
58.98
7.52
7.54
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
EPO
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
HMO
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
Medicaid
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
Medicare Part A
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
Medicare Part B
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
POS
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
PPO
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
84703
null
cpt
Gonadotropin (reproductive hormone) analysis
webtpa
Workers Comp
O
58.98
7.52
41.29
42.14
9.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
EPO
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
HMO
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
Medicaid
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
Medicare Part A
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
Medicare Part B
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
POS
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
PPO
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield
Workers Comp
O
28.77
2.37
7.22
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
EPO
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
HMO
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
Medicaid
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
POS
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
PPO
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
blue cross blue shield - medicare advantage
Workers Comp
O
28.77
2.37
5.23
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
EPO
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
HMO
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
Medicaid
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
Medicare Part A
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
Medicare Part B
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
POS
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
PPO
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
cigna
Workers Comp
O
28.77
2.37
18.13
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
EPO
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
HMO
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
Medicaid
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
Medicare Part A
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
Medicare Part B
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
POS
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
PPO
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
humana - medicare advantage
Workers Comp
O
28.77
2.37
2.37
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
EPO
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
HMO
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
Medicaid
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
Medicare Part A
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
Medicare Part B
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
POS
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
PPO
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
tricare
Workers Comp
O
28.77
2.37
2.38
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
EPO
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
HMO
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
Medicaid
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
Medicare Part A
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
Medicare Part B
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
POS
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
PPO
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85014
null
cpt
Red blood cell concentration measurement
united healthcare
Workers Comp
O
28.77
2.37
30.21
30.21
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
EPO
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
HMO
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
Medicaid
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
Medicare Part A
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
Medicare Part B
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
POS
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
PPO
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield
Workers Comp
O
33.02
2.37
7.41
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
EPO
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
HMO
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
Medicaid
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
Medicare Part A
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
Medicare Part B
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
POS
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
PPO
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
blue cross blue shield - medicare advantage
Workers Comp
O
33.02
2.37
5.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
EPO
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
HMO
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
Medicaid
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
Medicare Part A
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
Medicare Part B
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
POS
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
PPO
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
cigna
Workers Comp
O
33.02
2.37
20.81
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
EPO
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
HMO
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
Medicaid
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
Medicare Part A
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
Medicare Part B
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
POS
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
PPO
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
humana - medicare advantage
Workers Comp
O
33.02
2.37
2.37
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
EPO
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
HMO
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
Medicaid
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
Medicare Part A
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
Medicare Part B
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
POS
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
PPO
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
tricare
Workers Comp
O
33.02
2.37
2.38
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
EPO
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
HMO
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
Medicaid
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
Medicare Part A
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
Medicare Part B
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
POS
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
PPO
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85018
null
cpt
Blood count hemoglobin
united healthcare
Workers Comp
O
33.02
2.37
31.01
31.01
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
EPO
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
HMO
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
Medicaid
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
Medicare Part A
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
Medicare Part B
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
POS
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
PPO
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna
Workers Comp
O
83.80
4.66
48.60
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
EPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
HMO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
Medicaid
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
Medicare Part A
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
Medicare Part B
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
POS
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
PPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
aetna - medicare advantage
Workers Comp
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
EPO
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
HMO
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
Medicaid
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
Medicare Part A
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
Medicare Part B
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
POS
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
PPO
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield
Workers Comp
O
83.80
4.66
15.47
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
EPO
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
HMO
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
Medicaid
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
Medicare Part A
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
Medicare Part B
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
POS
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
PPO
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
blue cross blue shield - medicare advantage
Workers Comp
O
83.80
4.66
17.22
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
EPO
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
HMO
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
Medicaid
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
Medicare Part A
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
Medicare Part B
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
POS
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
PPO
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
cigna
Workers Comp
O
83.80
4.66
59.30
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
EPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
HMO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
Medicaid
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
Medicare Part A
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
Medicare Part B
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
POS
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
PPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
geha
Workers Comp
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
EPO
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
HMO
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
Medicaid
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
Medicare Part A
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
Medicare Part B
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
POS
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
PPO
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
healthchoice
Workers Comp
O
83.80
4.66
40.85
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
EPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
HMO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
Medicaid
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
Medicare Part A
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
Medicare Part B
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
POS
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
PPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana
Workers Comp
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
EPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
HMO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
Medicaid
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
Medicare Part A
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
Medicare Part B
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
POS
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
PPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
humana - medicare advantage
Workers Comp
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
EPO
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
HMO
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
Medicaid
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
Medicare Part A
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
Medicare Part B
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
POS
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
PPO
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
medica
Workers Comp
O
83.80
4.66
4.66
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
EPO
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
HMO
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
Medicaid
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
Medicare Part A
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
Medicare Part B
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
POS
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
PPO
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
tricare
Workers Comp
O
83.80
4.66
7.80
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
EPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
HMO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
Medicaid
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
Medicare Part A
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
Medicare Part B
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
POS
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
PPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare
Workers Comp
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
EPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
HMO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
Medicaid
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
Medicare Part A
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
Medicare Part B
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
POS
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
PPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
united healthcare - medicare advantage
Workers Comp
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
EPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
HMO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
Medicaid
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
Medicare Part A
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
Medicare Part B
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
POS
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
PPO
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
va
Workers Comp
O
83.80
4.66
7.77
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
EPO
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
HMO
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
Medicaid
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
Medicare Part A
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
Medicare Part B
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
POS
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
PPO
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
webtpa
Workers Comp
O
83.80
4.66
55.87
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
EPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
HMO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
Medicaid
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
Medicare Part A
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
Medicare Part B
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
POS
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
PPO
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85025
null
cpt
Complete blood cell count with differential white blood cells automated
worker comp
Workers Comp
O
83.80
4.66
59.86
59.86
9.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
EPO
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
HMO
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
Medicaid
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
Medicare Part A
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
Medicare Part B
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
POS
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
PPO
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna
Workers Comp
O
53.08
6.47
29.83
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
EPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
HMO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
Medicaid
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
Medicare Part A
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
Medicare Part B
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
POS
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
PPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
aetna - medicare advantage
Workers Comp
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
EPO
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
HMO
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
Medicaid
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
Medicare Part A
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
Medicare Part B
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
POS
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
PPO
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield
Workers Comp
O
53.08
6.47
10.77
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
EPO
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
HMO
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
Medicaid
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
Medicare Part A
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
Medicare Part B
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
POS
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
PPO
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
blue cross blue shield - medicare advantage
Workers Comp
O
53.08
6.47
10.81
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
EPO
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
HMO
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
Medicaid
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
Medicare Part A
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
Medicare Part B
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
POS
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
PPO
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
cigna
Workers Comp
O
53.08
6.47
37.57
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
EPO
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
HMO
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
Medicaid
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
Medicare Part A
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
Medicare Part B
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
POS
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
PPO
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
healthchoice
Workers Comp
O
53.08
6.47
10.55
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
EPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
HMO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
Medicaid
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
Medicare Part A
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
Medicare Part B
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
POS
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
PPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana
Workers Comp
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
EPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
HMO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
Medicaid
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
Medicare Part A
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
Medicare Part B
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
POS
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
PPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
humana - medicare advantage
Workers Comp
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
EPO
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
HMO
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
Medicaid
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
Medicare Part A
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
Medicare Part B
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
POS
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
PPO
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
medica
Workers Comp
O
53.08
6.47
19.64
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
EPO
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
HMO
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
Medicaid
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
Medicare Part A
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
Medicare Part B
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
POS
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
PPO
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
tricare
Workers Comp
O
53.08
6.47
6.50
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
EPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
HMO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
Medicaid
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
Medicare Part A
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
Medicare Part B
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
POS
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
PPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare
Workers Comp
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
EPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
HMO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
Medicaid
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
Medicare Part A
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
Medicare Part B
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
POS
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
PPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
united healthcare - medicare advantage
Workers Comp
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
EPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
HMO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
Medicaid
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
Medicare Part A
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
Medicare Part B
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
POS
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
PPO
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
va
Workers Comp
O
53.08
6.47
6.47
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
EPO
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
HMO
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
Medicaid
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
Medicare Part A
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
Medicare Part B
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
POS
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
PPO
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
webtpa
Workers Comp
O
53.08
6.47
35.39
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
EPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
HMO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
Medicaid
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
Medicare Part A
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
Medicare Part B
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
POS
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
PPO
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85027
null
cpt
Complete blood count automated
worker comp
Workers Comp
O
53.08
6.47
37.92
37.92
7.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
EPO
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
HMO
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
Medicaid
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
Medicare Part A
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
Medicare Part B
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
POS
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
PPO
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield
Workers Comp
O
18.92
2.27
3.01
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
EPO
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
HMO
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
Medicaid
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
Medicare Part A
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
Medicare Part B
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
POS
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
PPO
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
blue cross blue shield - medicare advantage
Workers Comp
O
18.92
2.27
2.27
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
EPO
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
HMO
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
Medicaid
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
Medicare Part A
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
Medicare Part B
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
POS
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
PPO
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
humana - medicare advantage
Workers Comp
O
18.92
2.27
3.02
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
EPO
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
HMO
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
Medicaid
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
Medicare Part A
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
Medicare Part B
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
POS
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
PPO
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
tricare
Workers Comp
O
18.92
2.27
3.03
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
EPO
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
HMO
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
Medicaid
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
Medicare Part A
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
Medicare Part B
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
POS
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
PPO
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85041
null
cpt
Red blood cell count automated test
united healthcare
Workers Comp
O
18.92
2.27
13.52
13.52
3.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
EPO
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
HMO
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
Medicaid
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
Medicare Part A
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
Medicare Part B
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
POS
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
PPO
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
aetna
Workers Comp
O
36.72
3.99
36.31
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
EPO
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
HMO
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
Medicaid
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
Medicare Part A
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
Medicare Part B
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
POS
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
PPO
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield
Workers Comp
O
36.72
3.99
5.26
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
EPO
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
HMO
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
Medicaid
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
Medicare Part A
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
Medicare Part B
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
POS
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
PPO
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
blue cross blue shield - medicare advantage
Workers Comp
O
36.72
3.99
6.30
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
EPO
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
HMO
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
Medicaid
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
Medicare Part A
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
Medicare Part B
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
POS
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
PPO
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
cigna
Workers Comp
O
36.72
3.99
24.52
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
EPO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
HMO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
Medicaid
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
Medicare Part A
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
Medicare Part B
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
POS
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
PPO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
humana - medicare advantage
Workers Comp
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
EPO
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
HMO
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
Medicaid
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
Medicare Part A
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
Medicare Part B
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
POS
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
PPO
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
tricare
Workers Comp
O
36.72
3.99
4.01
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
EPO
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
HMO
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
Medicaid
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
Medicare Part A
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
Medicare Part B
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
POS
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
PPO
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
united healthcare
Workers Comp
O
36.72
3.99
26.24
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
EPO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
HMO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
Medicaid
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
Medicare Part A
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
Medicare Part B
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
POS
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
PPO
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85045
null
cpt
Red blood count automated test
va
Workers Comp
O
36.72
3.99
3.99
36.31
4.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
EPO
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
HMO
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
Medicaid
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
Medicare Part A
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
Medicare Part B
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
POS
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
PPO
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield
Workers Comp
O
34.27
4.48
8.07
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
EPO
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
HMO
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
Medicaid
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
Medicare Part A
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
Medicare Part B
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
POS
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
PPO
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
blue cross blue shield - medicare advantage
Workers Comp
O
34.27
4.48
10.44
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
EPO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
HMO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
Medicaid
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
Medicare Part A
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
Medicare Part B
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
POS
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
PPO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
humana - medicare advantage
Workers Comp
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
EPO
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
HMO
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
Medicaid
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
Medicare Part A
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
Medicare Part B
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
POS
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
PPO
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
tricare
Workers Comp
O
34.27
4.48
4.50
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
EPO
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
HMO
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
Medicaid
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
Medicare Part A
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
Medicare Part B
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
POS
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
PPO
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
united healthcare
Workers Comp
O
34.27
4.48
25.70
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
EPO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
HMO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
Medicaid
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
Medicare Part A
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
Medicare Part B
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
POS
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
PPO
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85049
null
cpt
Platelet count automated test
va
Workers Comp
O
34.27
4.48
4.48
25.70
5.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
EPO
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
HMO
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
Medicaid
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
Medicare Part A
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
Medicare Part B
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
POS
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
PPO
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
blue cross blue shield
Workers Comp
O
110.36
11.60
11.60
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
EPO
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
HMO
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
Medicaid
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
Medicare Part A
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
Medicare Part B
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
POS
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
PPO
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85240
null
cpt
Clotting factor VIII (AHG) measurement
tricare
Workers Comp
O
110.36
11.60
17.97
17.97
66.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
EPO
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
HMO
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
Medicaid
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
Medicare Part A
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
Medicare Part B
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
POS
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
PPO
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
blue cross blue shield
Workers Comp
O
57.35
23.03
27.85
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
EPO
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
HMO
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
Medicaid
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
Medicare Part A
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
Medicare Part B
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
POS
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
PPO
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85245
null
cpt
Clotting factor VIII (VW factor) measurement
tricare
Workers Comp
O
57.35
23.03
23.03
27.85
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
EPO
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
HMO
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
Medicaid
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
Medicare Part A
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
Medicare Part B
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
POS
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
PPO
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
blue cross blue shield
Workers Comp
O
145.80
14.86
14.86
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
EPO
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
HMO
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
Medicaid
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
Medicare Part A
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
Medicare Part B
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
POS
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
PPO
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85246
null
cpt
Clotting factor VIII (VW factor) antigen
tricare
Workers Comp
O
145.80
14.86
23.03
23.03
87.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
EPO
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
HMO
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
Medicaid
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
Medicare Part A
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
Medicare Part B
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
POS
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
PPO
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
blue cross blue shield
Workers Comp
O
57.35
14.86
14.86
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
EPO
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
HMO
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
Medicaid
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
Medicare Part A
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
Medicare Part B
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
POS
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
PPO
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85247
null
cpt
Clotting factor VIII (von Willebrand factor) measurement
tricare
Workers Comp
O
57.35
14.86
23.03
23.03
34.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
EPO
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
HMO
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
Medicaid
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
Medicare Part A
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
Medicare Part B
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
POS
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
PPO
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
aetna - medicare advantage
Workers Comp
I
108428.68
27204.52
27204.52
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
EPO
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
HMO
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
Medicaid
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
Medicare Part A
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
Medicare Part B
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
POS
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
PPO
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
blue cross blue shield
Workers Comp
I
108428.68
27204.52
57688.88
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
EPO
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
HMO
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
Medicaid
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
Medicare Part A
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
Medicare Part B
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
POS
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
PPO
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
humana - medicare advantage
Workers Comp
I
108428.68
27204.52
28746.99
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
EPO
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
HMO
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
Medicaid
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
Medicare Part A
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
Medicare Part B
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
POS
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
PPO
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
tricare
Workers Comp
I
108428.68
27204.52
30321.61
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
EPO
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
HMO
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
Medicaid
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
Medicare Part A
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
Medicare Part B
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
POS
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
PPO
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
853
null
ms-drg
infectious and parasitic diseases with o.r. procedures with mcc
va
Workers Comp
I
108428.68
27204.52
31695.29
57688.88
65057.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
EPO
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
HMO
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
Medicaid
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
Medicare Part A
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
Medicare Part B
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
POS
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
PPO
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85301
null
cpt
Antithrombin III antigen (clotting inhibitor) level
united healthcare
Workers Comp
O
53.42
38.16
38.16
38.16
32.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
EPO
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
HMO
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
Medicaid
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
Medicare Part A
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
Medicare Part B
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
POS
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
PPO
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85303
null
cpt
Protein C antigen (clotting inhibitor) measurement
united healthcare
Workers Comp
O
249.31
178.08
178.08
178.08
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
EPO
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
HMO
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
Medicaid
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
Medicare Part A
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
Medicare Part B
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
POS
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
PPO
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85306
null
cpt
Protein S (clotting inhibitor) measurement
united healthcare
Workers Comp
O
176.96
126.41
126.41
126.41
106.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
EPO
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
HMO
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
Medicaid
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
Medicare Part A
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
Medicare Part B
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
POS
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
PPO
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield
Workers Comp
O
109.73
35.60
49.78
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
EPO
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
HMO
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
Medicaid
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
Medicare Part A
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
Medicare Part B
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
POS
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
PPO
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85347
null
cpt
Coagulation time measurement activated
blue cross blue shield - medicare advantage
Workers Comp
O
109.73
35.60
35.60
49.78
23.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
EPO
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
HMO
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
Medicaid
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
Medicare Part A
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
Medicare Part B
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
POS
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
PPO
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna
Workers Comp
O
115.63
10.18
66.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
EPO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
HMO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
Medicaid
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
Medicare Part A
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
Medicare Part B
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
POS
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
PPO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
aetna - medicare advantage
Workers Comp
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
EPO
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
HMO
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
Medicaid
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
Medicare Part A
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
Medicare Part B
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
POS
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
PPO
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield
Workers Comp
O
115.63
10.18
25.03
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
EPO
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
HMO
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
Medicaid
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
Medicare Part A
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
Medicare Part B
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
POS
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
PPO
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
blue cross blue shield - medicare advantage
Workers Comp
O
115.63
10.18
24.33
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
EPO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
HMO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
Medicaid
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
Medicare Part A
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
Medicare Part B
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
POS
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
PPO
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
humana - medicare advantage
Workers Comp
O
115.63
10.18
10.18
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
EPO
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
HMO
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
Medicaid
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
Medicare Part A
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
Medicare Part B
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
POS
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
PPO
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
medica
Workers Comp
O
115.63
10.18
42.78
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
EPO
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
HMO
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
Medicaid
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
Medicare Part A
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
Medicare Part B
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
POS
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
PPO
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
tricare
Workers Comp
O
115.63
10.18
10.22
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
EPO
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
HMO
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
Medicaid
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
Medicare Part A
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
Medicare Part B
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
POS
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
PPO
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
united healthcare
Workers Comp
O
115.63
10.18
82.60
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
EPO
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
HMO
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
Medicaid
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
Medicare Part A
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
Medicare Part B
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
POS
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
PPO
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85379
null
cpt
Coagulation function measurement D-dimer; quantitative
webtpa
Workers Comp
O
115.63
10.18
77.09
82.60
12.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
EPO
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
HMO
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
Medicaid
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
Medicare Part A
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
Medicare Part B
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
POS
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
PPO
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield
Workers Comp
O
85.43
9.72
11.80
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
EPO
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
HMO
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
Medicaid
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
POS
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
PPO
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
blue cross blue shield - medicare advantage
Workers Comp
O
85.43
9.72
53.08
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
EPO
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
HMO
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
Medicaid
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
Medicare Part A
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
Medicare Part B
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
POS
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
PPO
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
humana - medicare advantage
Workers Comp
O
85.43
9.72
9.72
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
EPO
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
HMO
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
Medicaid
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
Medicare Part A
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
Medicare Part B
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
POS
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
PPO
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
tricare
Workers Comp
O
85.43
9.72
9.76
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
EPO
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
HMO
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
Medicaid
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
Medicare Part A
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
Medicare Part B
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
POS
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
PPO
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85384
null
cpt
Fibrinogen (factor 1) activity measurement
united healthcare
Workers Comp
O
85.43
9.72
51.00
53.08
11.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
EPO
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
HMO
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
Medicaid
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
Medicare Part A
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
Medicare Part B
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
POS
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
PPO
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
humana - medicare advantage
Workers Comp
I
52091.29
11125.66
13701.23
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
EPO
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
HMO
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
Medicaid
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
Medicare Part A
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
Medicare Part B
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
POS
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
PPO
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
tricare
Workers Comp
I
52091.29
11125.66
11125.66
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
EPO
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
HMO
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
Medicaid
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
Medicare Part A
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
Medicare Part B
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
POS
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
PPO
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
united healthcare
Workers Comp
I
52091.29
11125.66
29670.79
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
EPO
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
HMO
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
Medicaid
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
Medicare Part A
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
Medicare Part B
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
POS
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
PPO
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
854
null
ms-drg
infectious and parasitic diseases with o.r. procedures with cc
va
Workers Comp
I
52091.29
11125.66
13556.51
29670.79
31254.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
EPO
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
HMO
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
Medicaid
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
Medicare Part A
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
Medicare Part B
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
POS
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
PPO
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85520
null
cpt
Heparin assay
aetna
Workers Comp
O
67.89
39.38
39.38
39.38
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
EPO
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
HMO
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
Medicaid
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
Medicare Part A
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
Medicare Part B
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
POS
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
PPO
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
aetna
Workers Comp
O
82.57
9.79
51.10
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
EPO
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
HMO
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
Medicaid
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
Medicare Part A
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
Medicare Part B
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
POS
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
PPO
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield
Workers Comp
O
82.57
9.79
12.36
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
EPO
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
HMO
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
Medicaid
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
Medicare Part A
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
Medicare Part B
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
POS
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
PPO
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
blue cross blue shield - medicare advantage
Workers Comp
O
82.57
9.79
9.79
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
EPO
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
HMO
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
Medicaid
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
Medicare Part A
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
Medicare Part B
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
POS
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
PPO
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
tricare
Workers Comp
O
82.57
9.79
18.05
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
EPO
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
HMO
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
Medicaid
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
Medicare Part A
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
Medicare Part B
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
POS
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
PPO
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85597
null
cpt
Platelet function test
united healthcare
Workers Comp
O
82.57
9.79
60.42
60.42
22.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
EPO
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
HMO
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
Medicaid
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
Medicare Part A
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
Medicare Part B
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
POS
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
PPO
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna
Workers Comp
O
34.27
0.38
19.88
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
EPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
HMO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
Medicaid
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
Medicare Part A
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
Medicare Part B
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
POS
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
PPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
aetna - medicare advantage
Workers Comp
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
EPO
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
HMO
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
Medicaid
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
Medicare Part A
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
Medicare Part B
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
POS
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
PPO
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield
Workers Comp
O
34.27
0.38
8.70
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
EPO
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
HMO
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
Medicaid
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
Medicare Part A
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
Medicare Part B
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
POS
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
PPO
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
blue cross blue shield - medicare advantage
Workers Comp
O
34.27
0.38
8.77
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
EPO
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
HMO
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
Medicaid
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
Medicare Part A
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
Medicare Part B
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
POS
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
PPO
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
cigna
Workers Comp
O
34.27
0.38
24.25
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
EPO
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
HMO
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
Medicaid
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
Medicare Part A
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
Medicare Part B
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
POS
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
PPO
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
healthchoice
Workers Comp
O
34.27
0.38
0.38
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
EPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
HMO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
Medicaid
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
Medicare Part A
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
Medicare Part B
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
POS
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
PPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
humana - medicare advantage
Workers Comp
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
EPO
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
HMO
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
Medicaid
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
Medicare Part A
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
Medicare Part B
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
POS
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
PPO
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
tricare
Workers Comp
O
34.27
0.38
4.31
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
EPO
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
HMO
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
Medicaid
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
Medicare Part A
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
Medicare Part B
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
POS
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
PPO
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare
Workers Comp
O
34.27
0.38
24.48
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
EPO
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
HMO
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
Medicaid
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
Medicare Part A
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
Medicare Part B
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
POS
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
PPO
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
united healthcare - medicare advantage
Workers Comp
O
34.27
0.38
4.30
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
EPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
HMO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
Medicaid
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
Medicare Part A
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
Medicare Part B
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
POS
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
PPO
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85610
null
cpt
Blood test clotting time
va
Workers Comp
O
34.27
0.38
4.29
24.48
5.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
EPO
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
HMO
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
Medicaid
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
Medicare Part A
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
Medicare Part B
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
POS
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
PPO
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
aetna
Workers Comp
O
41.29
4.90
25.55
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
EPO
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
HMO
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
Medicaid
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
Medicare Part A
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
Medicare Part B
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
POS
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
PPO
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield
Workers Comp
O
41.29
4.90
6.18
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
EPO
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
HMO
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
Medicaid
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
Medicare Part A
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
Medicare Part B
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
POS
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
PPO
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
blue cross blue shield - medicare advantage
Workers Comp
O
41.29
4.90
4.90
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
EPO
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
HMO
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
Medicaid
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
Medicare Part A
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
Medicare Part B
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
POS
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
PPO
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
tricare
Workers Comp
O
41.29
4.90
9.62
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
EPO
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
HMO
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
Medicaid
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
Medicare Part A
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
Medicare Part B
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
POS
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
PPO
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85613
null
cpt
Clotting factor X assessment test diluted
united healthcare
Workers Comp
O
41.29
4.90
30.21
30.21
11.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
EPO
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
HMO
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
Medicaid
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
Medicare Part A
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
Medicare Part B
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
POS
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
PPO
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
blue cross blue shield
Workers Comp
O
13.00
2.12
2.12
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
EPO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
HMO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
Medicaid
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
Medicare Part A
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
Medicare Part B
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
POS
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
PPO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
humana - medicare advantage
Workers Comp
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
EPO
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
HMO
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
Medicaid
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
Medicare Part A
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
Medicare Part B
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
POS
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
PPO
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
tricare
Workers Comp
O
13.00
2.12
4.29
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
EPO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
HMO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
Medicaid
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
Medicare Part A
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
Medicare Part B
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
POS
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
PPO
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85651
null
cpt
Red blood cell sedimentation rate to detect inflammation non-automated
va
Workers Comp
O
13.00
2.12
4.27
4.29
7.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
EPO
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
HMO
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
Medicaid
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
Medicare Part A
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
Medicare Part B
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
POS
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
PPO
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna
Workers Comp
O
36.72
1.81
20.97
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
EPO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
HMO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
Medicaid
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
Medicare Part A
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
Medicare Part B
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
POS
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
PPO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
aetna - medicare advantage
Workers Comp
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
EPO
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
HMO
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
Medicaid
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
Medicare Part A
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
Medicare Part B
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
POS
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
PPO
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield
Workers Comp
O
36.72
1.81
6.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
EPO
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
HMO
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
Medicaid
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
Medicare Part A
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
Medicare Part B
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
POS
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
PPO
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
blue cross blue shield - medicare advantage
Workers Comp
O
36.72
1.81
6.51
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
EPO
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
HMO
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
Medicaid
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
Medicare Part A
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
Medicare Part B
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
POS
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
PPO
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
healthchoice
Workers Comp
O
36.72
1.81
7.11
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
EPO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
HMO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
Medicaid
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
Medicare Part A
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
Medicare Part B
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
POS
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
PPO
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
humana - medicare advantage
Workers Comp
O
36.72
1.81
2.70
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
EPO
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
HMO
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
Medicaid
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
Medicare Part A
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
Medicare Part B
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
POS
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
PPO
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
tricare
Workers Comp
O
36.72
1.81
2.71
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
EPO
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
HMO
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
Medicaid
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
Medicare Part A
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
Medicare Part B
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
POS
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
PPO
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare
Workers Comp
O
36.72
1.81
26.24
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
EPO
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
HMO
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
Medicaid
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
Medicare Part A
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
Medicare Part B
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
POS
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
PPO
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
united healthcare - medicare advantage
Workers Comp
O
36.72
1.81
2.95
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
EPO
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
HMO
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
Medicaid
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
Medicare Part A
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
Medicare Part B
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
POS
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
PPO
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
va
Workers Comp
O
36.72
1.81
1.81
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
EPO
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
HMO
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
Medicaid
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
Medicare Part A
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
Medicare Part B
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
POS
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
PPO
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85652
null
cpt
Red blood cell sedimentation rate to detect inflammation automated
webtpa
Workers Comp
O
36.72
1.81
15.94
26.24
3.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
EPO
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
HMO
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
Medicaid
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
Medicare Part A
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
Medicare Part B
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
POS
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
PPO
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield
Workers Comp
O
34.27
5.53
8.55
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
EPO
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
HMO
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
Medicaid
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
POS
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
PPO
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
blue cross blue shield - medicare advantage
Workers Comp
O
34.27
5.53
11.37
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
EPO
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
HMO
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
Medicaid
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
Medicare Part A
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
Medicare Part B
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
POS
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
PPO
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85660
null
cpt
Red blood cell sickling measurement
tricare
Workers Comp
O
34.27
5.53
5.53
11.37
6.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
EPO
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
HMO
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
Medicaid
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
Medicare Part A
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
Medicare Part B
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
POS
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
PPO
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
857
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures with cc
humana - medicare advantage
Workers Comp
I
47754.37
13097.80
13097.80
13097.80
28652.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
EPO
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
HMO
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
Medicaid
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
Medicare Part A
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
Medicare Part B
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
POS
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
PPO
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna
Workers Comp
O
47.85
0.54
27.75
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
EPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
HMO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
Medicaid
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
Medicare Part A
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
Medicare Part B
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
POS
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
PPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
aetna - medicare advantage
Workers Comp
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
EPO
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
HMO
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
Medicaid
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
Medicare Part A
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
Medicare Part B
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
POS
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
PPO
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield
Workers Comp
O
47.85
0.54
10.00
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
EPO
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
HMO
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
Medicaid
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
Medicare Part A
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
Medicare Part B
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
POS
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
PPO
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
blue cross blue shield - medicare advantage
Workers Comp
O
47.85
0.54
8.96
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
EPO
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
HMO
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
Medicaid
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
Medicare Part A
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
Medicare Part B
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
POS
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
PPO
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
cigna
Workers Comp
O
47.85
0.54
33.87
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
EPO
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
HMO
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
Medicaid
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
Medicare Part A
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
Medicare Part B
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
POS
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
PPO
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
healthchoice
Workers Comp
O
47.85
0.54
0.54
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
EPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
HMO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
Medicaid
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
Medicare Part A
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
Medicare Part B
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
POS
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
PPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
humana - medicare advantage
Workers Comp
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
EPO
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
HMO
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
Medicaid
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
Medicare Part A
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
Medicare Part B
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
POS
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
PPO
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
tricare
Workers Comp
O
47.85
0.54
6.03
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
EPO
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
HMO
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
Medicaid
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
Medicare Part A
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
Medicare Part B
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
POS
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
PPO
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare
Workers Comp
O
47.85
0.54
34.19
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
EPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
HMO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
Medicaid
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
Medicare Part A
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
Medicare Part B
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
POS
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
PPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
united healthcare - medicare advantage
Workers Comp
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
EPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
HMO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
Medicaid
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
Medicare Part A
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
Medicare Part B
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
POS
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
PPO
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
va
Workers Comp
O
47.85
0.54
6.01
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
EPO
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
HMO
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
Medicaid
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
Medicare Part A
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
Medicare Part B
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
POS
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
PPO
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85730
null
cpt
Blood Coagulation Test
webtpa
Workers Comp
O
47.85
0.54
33.50
34.19
7.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
EPO
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
HMO
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
Medicaid
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
Medicare Part A
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
Medicare Part B
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
POS
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
PPO
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
aetna
Workers Comp
O
32.60
3.86
20.17
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
EPO
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
HMO
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
Medicaid
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
Medicare Part A
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
Medicare Part B
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
POS
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
PPO
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield
Workers Comp
O
32.60
3.86
4.88
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
EPO
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
HMO
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
Medicaid
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
Medicare Part A
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
Medicare Part B
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
POS
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
PPO
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
blue cross blue shield - medicare advantage
Workers Comp
O
32.60
3.86
3.86
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
EPO
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
HMO
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
Medicaid
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
Medicare Part A
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
Medicare Part B
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
POS
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
PPO
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
tricare
Workers Comp
O
32.60
3.86
6.50
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
EPO
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
HMO
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
Medicaid
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
Medicare Part A
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
Medicare Part B
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
POS
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
PPO
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
85732
null
cpt
Coagulation assessment blood test substitution plasma fractions
united healthcare
Workers Comp
O
32.60
3.86
23.85
23.85
8.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
EPO
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
HMO
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
Medicaid
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
POS
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
PPO
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
858
null
ms-drg
postoperative or post-traumatic infections with o.r. procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
36289.64
7502.24
7502.24
7502.24
21773.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
EPO
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
HMO
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
Medicaid
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
Medicare Part A
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
Medicare Part B
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
POS
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
PPO
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86001
null
cpt
Measurement of antibody (IgG) to allergic substance each allergen
blue cross blue shield
Workers Comp
O
27.82
4.38
4.38
4.38
16.69


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
EPO
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
HMO
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
Medicaid
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
Medicare Part A
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
Medicare Part B
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
POS
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
PPO
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
aetna
Workers Comp
O
38.95
5.05
897.45
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
EPO
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
HMO
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
Medicaid
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
Medicare Part A
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
Medicare Part B
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
POS
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
PPO
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield
Workers Comp
O
38.95
5.05
6.20
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
EPO
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
HMO
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
Medicaid
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
Medicare Part A
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
Medicare Part B
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
POS
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
PPO
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
blue cross blue shield - medicare advantage
Workers Comp
O
38.95
5.05
5.05
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
EPO
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
HMO
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
Medicaid
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
Medicare Part A
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
Medicare Part B
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
POS
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
PPO
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
humana - medicare advantage
Workers Comp
O
38.95
5.05
5.22
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
EPO
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
HMO
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
Medicaid
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
Medicare Part A
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
Medicare Part B
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
POS
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
PPO
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
tricare
Workers Comp
O
38.95
5.05
5.24
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
EPO
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
HMO
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
Medicaid
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
Medicare Part A
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
Medicare Part B
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
POS
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
PPO
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86003
null
cpt
Measurement of antibody (IgE) to allergic substance crude allergen extract each
webtpa
Workers Comp
O
38.95
5.05
18.21
897.45
23.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
EPO
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
HMO
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
Medicaid
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
Medicare Part A
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
Medicare Part B
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
POS
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
PPO
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield
Workers Comp
O
152.18
15.05
18.40
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
EPO
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
HMO
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
Medicaid
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part A
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part B
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
POS
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
PPO
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
blue cross blue shield - medicare advantage
Workers Comp
O
152.18
15.05
17.09
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
EPO
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
HMO
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
Medicaid
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
Medicare Part A
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
Medicare Part B
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
POS
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
PPO
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
humana - medicare advantage
Workers Comp
O
152.18
15.05
15.05
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
EPO
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
HMO
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
Medicaid
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
Medicare Part A
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
Medicare Part B
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
POS
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
PPO
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
tricare
Workers Comp
O
152.18
15.05
15.11
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
EPO
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
HMO
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
Medicaid
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
Medicare Part A
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
Medicare Part B
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
POS
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
PPO
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86021
null
cpt
Antibody identification test for white blood cell antibodies
united healthcare
Workers Comp
O
152.18
15.05
102.56
102.56
91.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
EPO
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
HMO
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
Medicaid
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
Medicare Part A
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
Medicare Part B
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
POS
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
PPO
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna
Workers Comp
O
102.56
7.28
59.99
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
EPO
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
HMO
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
Medicaid
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
Medicare Part A
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
Medicare Part B
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
POS
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
PPO
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
aetna - medicare advantage
Workers Comp
O
102.56
7.28
11.86
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
EPO
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
HMO
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
Medicaid
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
Medicare Part A
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
Medicare Part B
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
POS
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
PPO
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield
Workers Comp
O
102.56
7.28
14.97
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
EPO
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
HMO
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
Medicaid
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
Medicare Part A
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
Medicare Part B
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
POS
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
PPO
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
blue cross blue shield - medicare advantage
Workers Comp
O
102.56
7.28
16.29
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
EPO
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
HMO
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
Medicaid
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
Medicare Part A
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
Medicare Part B
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
POS
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
PPO
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
cigna
Workers Comp
O
102.56
7.28
74.34
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
EPO
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
HMO
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
Medicaid
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
Medicare Part A
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
Medicare Part B
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
POS
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
PPO
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
geha
Workers Comp
O
102.56
7.28
75.04
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
EPO
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
HMO
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
Medicaid
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
Medicare Part A
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
Medicare Part B
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
POS
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
PPO
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
healthchoice
Workers Comp
O
102.56
7.28
11.00
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
EPO
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
HMO
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
Medicaid
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
Medicare Part A
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
Medicare Part B
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
POS
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
PPO
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
humana - medicare advantage
Workers Comp
O
102.56
7.28
12.09
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
EPO
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
HMO
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
Medicaid
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
Medicare Part A
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
Medicare Part B
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
POS
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
PPO
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
tricare
Workers Comp
O
102.56
7.28
12.14
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
EPO
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
HMO
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
Medicaid
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
Medicare Part A
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
Medicare Part B
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
POS
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
PPO
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
united healthcare
Workers Comp
O
102.56
7.28
75.05
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
EPO
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
HMO
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
Medicaid
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
Medicare Part A
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
Medicare Part B
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
POS
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
PPO
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
va
Workers Comp
O
102.56
7.28
7.28
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
EPO
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
HMO
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
Medicaid
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
Medicare Part A
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
Medicare Part B
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
POS
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
PPO
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86038
null
cpt
Screening test for autoimmune disorder
webtpa
Workers Comp
O
102.56
7.28
73.54
75.05
14.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
EPO
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
HMO
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
Medicaid
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
Medicare Part A
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
Medicare Part B
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
POS
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
PPO
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
blue cross blue shield
Workers Comp
O
18.25
2.91
2.91
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
EPO
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
HMO
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
Medicaid
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
Medicare Part A
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
Medicare Part B
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
POS
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
PPO
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86060
null
cpt
Measurement for Strep antibody (strep throat)
tricare
Workers Comp
O
18.25
2.91
7.33
7.33
10.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
EPO
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
HMO
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
Medicaid
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
Medicare Part A
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
Medicare Part B
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
POS
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
PPO
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna
Workers Comp
O
63.76
5.18
36.98
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
EPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
HMO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
Medicaid
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
Medicare Part A
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
Medicare Part B
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
POS
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
PPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
aetna - medicare advantage
Workers Comp
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
EPO
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
HMO
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
Medicaid
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
Medicare Part A
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
Medicare Part B
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
POS
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
PPO
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield
Workers Comp
O
63.76
5.18
12.46
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
EPO
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
HMO
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
Medicaid
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
Medicare Part A
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
Medicare Part B
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
POS
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
PPO
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
blue cross blue shield - medicare advantage
Workers Comp
O
63.76
5.18
11.30
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
EPO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
HMO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
Medicaid
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
Medicare Part A
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
Medicare Part B
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
POS
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
PPO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
geha
Workers Comp
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
EPO
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
HMO
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
Medicaid
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
Medicare Part A
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
Medicare Part B
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
POS
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
PPO
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
healthchoice
Workers Comp
O
63.76
5.18
12.35
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
EPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
HMO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
Medicaid
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
Medicare Part A
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
Medicare Part B
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
POS
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
PPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
humana - medicare advantage
Workers Comp
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
EPO
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
HMO
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
Medicaid
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
Medicare Part A
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
Medicare Part B
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
POS
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
PPO
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
tricare
Workers Comp
O
63.76
5.18
5.20
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
EPO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
HMO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
Medicaid
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
Medicare Part A
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
Medicare Part B
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
POS
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
PPO
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare
Workers Comp
O
63.76
5.18
45.55
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
EPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
HMO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
Medicaid
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
Medicare Part A
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
Medicare Part B
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
POS
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
PPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
united healthcare - medicare advantage
Workers Comp
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
EPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
HMO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
Medicaid
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
Medicare Part A
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
Medicare Part B
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
POS
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
PPO
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
va
Workers Comp
O
63.76
5.18
5.18
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
EPO
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
HMO
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
Medicaid
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
Medicare Part A
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
Medicare Part B
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
POS
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
PPO
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86140
null
cpt
Measurement C-reactive protein for detection of infection or inflammation
webtpa
Workers Comp
O
63.76
5.18
42.51
45.55
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
EPO
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
HMO
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
Medicaid
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
Medicare Part A
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
Medicare Part B
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
POS
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
PPO
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield
Workers Comp
O
131.75
10.49
11.54
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
EPO
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
HMO
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
Medicaid
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
Medicare Part A
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
Medicare Part B
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
POS
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
PPO
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
blue cross blue shield - medicare advantage
Workers Comp
O
131.75
10.49
10.49
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
EPO
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
HMO
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
Medicaid
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
Medicare Part A
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
Medicare Part B
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
POS
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
PPO
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
cigna
Workers Comp
O
131.75
10.49
49.79
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
EPO
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
HMO
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
Medicaid
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
Medicare Part A
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
Medicare Part B
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
POS
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
PPO
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
humana - medicare advantage
Workers Comp
O
131.75
10.49
12.95
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
EPO
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
HMO
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
Medicaid
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
Medicare Part A
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
Medicare Part B
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
POS
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
PPO
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86141
null
cpt
Measurement C-reactive protein for detection of infection or inflammation high sensitivity
united healthcare
Workers Comp
O
131.75
10.49
54.60
54.60
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
EPO
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
HMO
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
Medicaid
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
Medicare Part A
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
Medicare Part B
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
POS
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
PPO
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86146
null
cpt
Beta 2 glycoprotein 1 antibody (autoantibody) measurement
tricare
Workers Comp
O
130.22
28.40
28.40
28.40
78.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
EPO
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
HMO
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
Medicaid
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
Medicare Part A
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
Medicare Part B
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
POS
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
PPO
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
aetna
Workers Comp
O
296.80
28.40
564.86
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
EPO
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
HMO
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
Medicaid
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
Medicare Part A
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
Medicare Part B
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
POS
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
PPO
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield
Workers Comp
O
296.80
28.40
38.17
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
EPO
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
HMO
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
Medicaid
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
POS
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
PPO
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
296.80
28.40
36.08
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
EPO
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
HMO
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
Medicaid
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
Medicare Part A
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
Medicare Part B
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
POS
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
PPO
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
tricare
Workers Comp
O
296.80
28.40
28.40
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
EPO
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
HMO
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
Medicaid
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
Medicare Part A
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
Medicare Part B
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
POS
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
PPO
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86147
null
cpt
Cardiolipin antibody (tissue antibody) measurement
united healthcare
Workers Comp
O
296.80
28.40
222.60
564.86
94.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
EPO
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
HMO
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
Medicaid
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
Medicare Part A
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
Medicare Part B
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
POS
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
PPO
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86148
null
cpt
Phospholipid antibody (autoimmune antibody) measurement
tricare
Workers Comp
O
84.83
17.92
17.92
17.92
50.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
EPO
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
HMO
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
Medicaid
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
Medicare Part A
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
Medicare Part B
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
POS
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
PPO
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86156
null
cpt
Measurement of cold agglutinin (protein) to screen for infection or disease
blue cross blue shield - medicare advantage
Workers Comp
O
323.75
14.51
14.51
14.51
194.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
EPO
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
HMO
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
Medicaid
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
Medicare Part A
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
Medicare Part B
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
POS
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
PPO
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
blue cross blue shield - medicare advantage
Workers Comp
O
50.72
5.85
5.85
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
EPO
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
HMO
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
Medicaid
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
Medicare Part A
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
Medicare Part B
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
POS
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
PPO
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
humana - medicare advantage
Workers Comp
O
50.72
5.85
12.00
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
EPO
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
HMO
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
Medicaid
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
Medicare Part A
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
Medicare Part B
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
POS
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
PPO
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86160
null
cpt
Measurement of complement (immune system proteins) antigen
tricare
Workers Comp
O
50.72
5.85
12.05
12.05
28.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
EPO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
HMO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
Medicaid
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
Medicare Part A
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
Medicare Part B
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
POS
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
PPO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
humana - medicare advantage
Workers Comp
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
EPO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
HMO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
Medicaid
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
Medicare Part A
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
Medicare Part B
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
POS
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
PPO
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86162
null
cpt
Measurement of complement (immune system proteins) total hemolytic
united healthcare - medicare advantage
Workers Comp
O
128.26
20.32
20.32
20.32
76.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
EPO
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
HMO
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
Medicaid
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
Medicare Part A
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
Medicare Part B
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
POS
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
PPO
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
cigna
Workers Comp
I
34277.40
7745.45
26149.85
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
EPO
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
HMO
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
Medicaid
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
Medicare Part A
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
Medicare Part B
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
POS
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
PPO
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
humana - medicare advantage
Workers Comp
I
34277.40
7745.45
10025.49
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
EPO
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
HMO
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
Medicaid
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
Medicare Part A
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
Medicare Part B
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
POS
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
PPO
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
862
null
ms-drg
postoperative and post-traumatic infections with mcc
tricare
Workers Comp
I
34277.40
7745.45
7745.45
26149.85
20566.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
EPO
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
HMO
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
Medicaid
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
Medicare Part A
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
Medicare Part B
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
POS
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
PPO
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna
Workers Comp
O
237.06
8.24
135.35
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
EPO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
HMO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
Medicaid
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
Medicare Part A
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
Medicare Part B
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
POS
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
PPO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
aetna - medicare advantage
Workers Comp
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
EPO
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
HMO
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
Medicaid
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
Medicare Part A
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
Medicare Part B
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
POS
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
PPO
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield
Workers Comp
O
237.06
8.24
34.76
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
EPO
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
HMO
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
Medicaid
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
Medicare Part A
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
Medicare Part B
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
POS
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
PPO
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
blue cross blue shield - medicare advantage
Workers Comp
O
237.06
8.24
31.80
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
EPO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
HMO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
Medicaid
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
Medicare Part A
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
Medicare Part B
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
POS
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
PPO
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
humana - medicare advantage
Workers Comp
O
237.06
8.24
12.95
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
EPO
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
HMO
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
Medicaid
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
Medicare Part A
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
Medicare Part B
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
POS
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
PPO
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
tricare
Workers Comp
O
237.06
8.24
13.00
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
EPO
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
HMO
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
Medicaid
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
Medicare Part A
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
Medicare Part B
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
POS
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
PPO
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare
Workers Comp
O
237.06
8.24
169.34
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
EPO
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
HMO
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
Medicaid
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
Medicare Part A
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
Medicare Part B
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
POS
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
PPO
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
united healthcare - medicare advantage
Workers Comp
O
237.06
8.24
14.14
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
EPO
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
HMO
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
Medicaid
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
Medicare Part A
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
Medicare Part B
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
POS
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
PPO
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86200
null
cpt
Measurement of antibody for rheumatoid arthritis assessment
va
Workers Comp
O
237.06
8.24
8.24
169.34
15.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
EPO
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
HMO
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
Medicaid
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
Medicare Part A
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
Medicare Part B
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
POS
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
PPO
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna
Workers Comp
O
41.33
6.53
167.81
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
EPO
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
HMO
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
Medicaid
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
Medicare Part A
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
Medicare Part B
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
POS
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
PPO
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
aetna - medicare advantage
Workers Comp
O
41.33
6.53
124.32
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
EPO
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
HMO
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
Medicaid
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
Medicare Part A
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
Medicare Part B
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
POS
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
PPO
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield
Workers Comp
O
41.33
6.53
8.15
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
EPO
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
HMO
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
Medicaid
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
Medicare Part A
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
Medicare Part B
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
POS
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
PPO
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
blue cross blue shield - medicare advantage
Workers Comp
O
41.33
6.53
6.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
EPO
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
HMO
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
Medicaid
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
Medicare Part A
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
Medicare Part B
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
POS
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
PPO
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
cigna
Workers Comp
O
41.33
6.53
24.25
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
EPO
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
HMO
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
Medicaid
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
Medicare Part A
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
Medicare Part B
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
POS
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
PPO
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
healthchoice
Workers Comp
O
41.33
6.53
8.01
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
EPO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
HMO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
Medicaid
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
Medicare Part A
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
Medicare Part B
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
POS
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
PPO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
humana - medicare advantage
Workers Comp
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
EPO
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
HMO
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
Medicaid
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
Medicare Part A
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
Medicare Part B
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
POS
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
PPO
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
tricare
Workers Comp
O
41.33
6.53
18.00
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
EPO
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
HMO
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
Medicaid
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
Medicare Part A
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
Medicare Part B
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
POS
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
PPO
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare
Workers Comp
O
41.33
6.53
29.53
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
EPO
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
HMO
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
Medicaid
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
Medicare Part A
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
Medicare Part B
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
POS
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
PPO
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
united healthcare - medicare advantage
Workers Comp
O
41.33
6.53
19.57
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
EPO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
HMO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
Medicaid
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
Medicare Part A
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
Medicare Part B
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
POS
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
PPO
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86235
null
cpt
Measurement of antibody for assessment of autoimmune disorder any method
va
Workers Comp
O
41.33
6.53
17.93
167.81
150.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
EPO
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
HMO
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
Medicaid
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
Medicare Part A
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
Medicare Part B
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
POS
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
PPO
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield
Workers Comp
O
87.92
5.40
10.92
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
EPO
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
HMO
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicaid
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
POS
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
PPO
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
5.40
5.40
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
EPO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
HMO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
Medicaid
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
Medicare Part A
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
Medicare Part B
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
POS
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
PPO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
humana - medicare advantage
Workers Comp
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
EPO
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
HMO
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
Medicaid
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
Medicare Part A
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
Medicare Part B
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
POS
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
PPO
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
tricare
Workers Comp
O
87.92
5.40
12.10
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
EPO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
HMO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
Medicaid
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
Medicare Part A
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
Medicare Part B
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
POS
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
PPO
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86255
null
cpt
Screening test for antibody to noninfectious agent
va
Workers Comp
O
87.92
5.40
12.05
12.10
14.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
EPO
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
HMO
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicaid
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicare Part A
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
Medicare Part B
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
POS
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
PPO
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86256
null
cpt
Measurement of antibody to noninfectious agent
blue cross blue shield - medicare advantage
Workers Comp
O
71.96
18.80
18.80
18.80
43.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
EPO
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
HMO
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
Medicaid
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
Medicare Part A
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
Medicare Part B
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
POS
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
PPO
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
tricare
Workers Comp
I
16602.56
3493.72
3493.72
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
EPO
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
HMO
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
Medicaid
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
Medicare Part A
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
Medicare Part B
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
POS
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
PPO
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
united healthcare - medicare advantage
Workers Comp
I
16602.56
3493.72
6721.76
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
EPO
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
HMO
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
Medicaid
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
Medicare Part A
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
Medicare Part B
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
POS
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
PPO
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
863
null
ms-drg
postoperative and post-traumatic infections without mcc
va
Workers Comp
I
16602.56
3493.72
7268.41
7268.41
9961.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
EPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
HMO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
Medicaid
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
Medicare Part A
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
Medicare Part B
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
POS
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
PPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna
Workers Comp
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
EPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
HMO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
Medicaid
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
Medicare Part A
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
Medicare Part B
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
POS
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
PPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
aetna - medicare advantage
Workers Comp
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
EPO
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
HMO
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
Medicaid
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
Medicare Part A
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
Medicare Part B
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
POS
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
PPO
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield
Workers Comp
O
85.70
20.81
77.89
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
EPO
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
HMO
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
Medicaid
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
Medicare Part A
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
Medicare Part B
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
POS
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
PPO
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
blue cross blue shield - medicare advantage
Workers Comp
O
85.70
20.81
79.34
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
EPO
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
HMO
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
Medicaid
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
Medicare Part A
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
Medicare Part B
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
POS
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
PPO
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
cigna
Workers Comp
O
85.70
20.81
57.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
EPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
HMO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
Medicaid
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
Medicare Part A
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
Medicare Part B
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
POS
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
PPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
humana - medicare advantage
Workers Comp
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
EPO
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
HMO
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
Medicaid
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
Medicare Part A
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
Medicare Part B
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
POS
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
PPO
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
tricare
Workers Comp
O
85.70
20.81
20.90
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
EPO
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
HMO
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
Medicaid
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
Medicare Part A
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
Medicare Part B
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
POS
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
PPO
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare
Workers Comp
O
85.70
20.81
61.22
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
EPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
HMO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
Medicaid
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
Medicare Part A
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
Medicare Part B
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
POS
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
PPO
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
united healthcare - medicare advantage
Workers Comp
O
85.70
20.81
20.81
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
EPO
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
HMO
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
Medicaid
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
Medicare Part A
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
Medicare Part B
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
POS
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
PPO
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86300
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 15-3
webtpa
Workers Comp
O
85.70
20.81
57.13
79.34
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
EPO
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
HMO
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
Medicaid
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
Medicare Part A
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
Medicare Part B
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
POS
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
PPO
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield
Workers Comp
O
95.71
20.81
60.09
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
EPO
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
HMO
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
Medicaid
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
POS
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
PPO
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
20.81
37.42
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
EPO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
HMO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
Medicaid
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
Medicare Part A
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
Medicare Part B
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
POS
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
PPO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
humana - medicare advantage
Workers Comp
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
EPO
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
HMO
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
Medicaid
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
Medicare Part A
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
Medicare Part B
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
POS
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
PPO
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
tricare
Workers Comp
O
95.71
20.81
20.90
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
EPO
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
HMO
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
Medicaid
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
Medicare Part A
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
Medicare Part B
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
POS
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
PPO
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
united healthcare
Workers Comp
O
95.71
20.81
71.78
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
EPO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
HMO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
Medicaid
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
Medicare Part A
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
Medicare Part B
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
POS
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
PPO
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86301
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 19-9
va
Workers Comp
O
95.71
20.81
20.81
71.78
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
EPO
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
HMO
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
Medicaid
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
Medicare Part A
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
Medicare Part B
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
POS
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
PPO
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield
Workers Comp
O
95.71
20.81
55.79
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
EPO
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
HMO
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
Medicaid
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
POS
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
PPO
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
20.81
30.20
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
EPO
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
HMO
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
Medicaid
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
Medicare Part A
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
Medicare Part B
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
POS
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
PPO
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
humana - medicare advantage
Workers Comp
O
95.71
20.81
20.81
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
EPO
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
HMO
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
Medicaid
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
Medicare Part A
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
Medicare Part B
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
POS
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
PPO
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86304
null
cpt
Immunologic analysis for detection of tumor antigen quantitative; CA 125
tricare
Workers Comp
O
95.71
20.81
23.22
55.79
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
EPO
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
HMO
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
Medicaid
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
Medicare Part A
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
Medicare Part B
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
POS
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
PPO
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
blue cross blue shield
Workers Comp
O
38.95
5.20
24.82
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
EPO
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
HMO
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
Medicaid
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
Medicare Part A
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
Medicare Part B
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
POS
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
PPO
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86308
null
cpt
Screening test for mononucleosis (mono)
tricare
Workers Comp
O
38.95
5.20
5.20
24.82
6.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
EPO
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
HMO
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
Medicaid
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
Medicare Part A
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
Medicare Part B
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
POS
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
PPO
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
blue cross blue shield
Workers Comp
O
116.86
17.36
17.36
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
EPO
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
HMO
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
Medicaid
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
Medicare Part A
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
Medicare Part B
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
POS
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
PPO
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
humana - medicare advantage
Workers Comp
O
116.86
17.36
20.81
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
EPO
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
HMO
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
Medicaid
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
Medicare Part A
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
Medicare Part B
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
POS
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
PPO
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86316
null
cpt
Analysis for detection of tumor marker
tricare
Workers Comp
O
116.86
17.36
20.90
20.90
24.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
EPO
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
HMO
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
Medicaid
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
Medicare Part A
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
Medicare Part B
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
POS
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
PPO
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
blue cross blue shield
Workers Comp
O
133.56
14.31
14.31
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
EPO
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
HMO
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
Medicaid
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
Medicare Part A
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
Medicare Part B
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
POS
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
PPO
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86317
null
cpt
Detection of infectious agent antibody quantitative
united healthcare
Workers Comp
O
133.56
14.31
100.17
100.17
80.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
EPO
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
HMO
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
Medicaid
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
Medicare Part A
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
Medicare Part B
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
POS
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
PPO
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86331
null
cpt
Immunologic analysis for detection of antigen or antibody
blue cross blue shield - medicare advantage
Workers Comp
O
29.95
12.93
12.93
12.93
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
EPO
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
HMO
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
Medicaid
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
Medicare Part A
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
Medicare Part B
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
POS
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
PPO
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86332
null
cpt
Immune complex measurement
worker comp
Workers Comp
O
148.40
111.30
111.30
111.30
89.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
EPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
HMO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
Medicaid
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
Medicare Part A
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
Medicare Part B
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
POS
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
PPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
aetna
Workers Comp
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
EPO
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
HMO
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
Medicaid
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
Medicare Part A
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
Medicare Part B
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
POS
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
PPO
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield
Workers Comp
O
124.65
17.20
18.52
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
EPO
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
HMO
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
Medicaid
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
Medicare Part A
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
Medicare Part B
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
POS
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
PPO
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
blue cross blue shield - medicare advantage
Workers Comp
O
124.65
17.20
17.20
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
EPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
HMO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
Medicaid
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
Medicare Part A
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
Medicare Part B
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
POS
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
PPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
humana - medicare advantage
Workers Comp
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
EPO
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
HMO
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
Medicaid
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
Medicare Part A
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
Medicare Part B
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
POS
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
PPO
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
tricare
Workers Comp
O
124.65
17.20
22.43
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
EPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
HMO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
Medicaid
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
Medicare Part A
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
Medicare Part B
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
POS
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
PPO
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86334
null
cpt
Immunologic analysis technique on serum (immunofixation)
va
Workers Comp
O
124.65
17.20
22.34
22.43
26.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
EPO
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
HMO
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
Medicaid
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
Medicare Part A
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
Medicare Part B
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
POS
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
PPO
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
aetna
Workers Comp
O
200.34
29.06
29.06
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
EPO
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
HMO
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
Medicaid
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
Medicare Part A
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
Medicare Part B
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
POS
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
PPO
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
humana - medicare advantage
Workers Comp
O
200.34
29.06
29.35
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
EPO
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
HMO
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
Medicaid
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
Medicare Part A
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
Medicare Part B
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
POS
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
PPO
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86335
null
cpt
Immunologic analysis technique on body fluid other fluids with concentration
tricare
Workers Comp
O
200.34
29.06
29.47
29.47
35.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
EPO
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
HMO
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
Medicaid
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
Medicare Part A
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
Medicare Part B
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
POS
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
PPO
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86336
null
cpt
Inhibin A (reproductive organ hormone) measurement
tricare
Workers Comp
O
38.98
15.65
15.65
15.65
23.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
EPO
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
HMO
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
POS
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
PPO
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
14.60
14.60
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
EPO
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
HMO
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
Medicaid
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
Medicare Part A
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
Medicare Part B
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
POS
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
PPO
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86337
null
cpt
Insulin antibody measurement
humana - medicare advantage
Workers Comp
O
95.71
14.60
21.41
21.41
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
EPO
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
HMO
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
Medicaid
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
Medicare Part A
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
Medicare Part B
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
POS
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
PPO
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86340
null
cpt
Intrinsic factor (stomach protein) antibody measurement
tricare
Workers Comp
O
156.93
16.82
16.82
16.82
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
EPO
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
HMO
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
Medicaid
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
Medicare Part A
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
Medicare Part B
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
POS
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
PPO
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield
Workers Comp
O
131.33
20.03
22.70
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
EPO
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
HMO
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
POS
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
PPO
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
131.33
20.03
20.03
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
EPO
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
HMO
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
Medicaid
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
Medicare Part A
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
Medicare Part B
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
POS
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
PPO
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86341
null
cpt
Islet cell (pancreas) antibody measurement
humana - medicare advantage
Workers Comp
O
131.33
20.03
23.57
23.57
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
EPO
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
HMO
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
Medicaid
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
Medicare Part A
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
Medicare Part B
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
POS
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
PPO
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
aetna
Workers Comp
O
208.13
46.98
123.24
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
EPO
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
HMO
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
Medicaid
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
Medicare Part A
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
Medicare Part B
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
POS
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
PPO
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86360
null
cpt
T cell count and ratio including ratio
humana - medicare advantage
Workers Comp
O
208.13
46.98
46.98
123.24
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
EPO
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
HMO
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
Medicaid
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
Medicare Part A
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
Medicare Part B
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
POS
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
PPO
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
aetna
Workers Comp
O
37.84
9.74
21.95
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
EPO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
HMO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
Medicaid
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
Medicare Part A
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
Medicare Part B
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
POS
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
PPO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield
Workers Comp
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
EPO
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
HMO
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
Medicaid
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
POS
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
PPO
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
37.84
9.74
17.33
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
EPO
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
HMO
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
Medicaid
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
Medicare Part A
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
Medicare Part B
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
POS
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
PPO
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
humana - medicare advantage
Workers Comp
O
37.84
9.74
14.55
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
EPO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
HMO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
Medicaid
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
Medicare Part A
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
Medicare Part B
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
POS
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
PPO
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
tricare
Workers Comp
O
37.84
9.74
14.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
EPO
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
HMO
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
Medicaid
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
Medicare Part A
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
Medicare Part B
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
POS
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
PPO
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
united healthcare
Workers Comp
O
37.84
9.74
67.61
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
EPO
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
HMO
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
Medicaid
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
Medicare Part A
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
Medicare Part B
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
POS
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
PPO
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
va
Workers Comp
O
37.84
9.74
9.74
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
EPO
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
HMO
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
Medicaid
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
Medicare Part A
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
Medicare Part B
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
POS
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
PPO
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86376
null
cpt
Microsomal antibodies (autoantibody) measurement
webtpa
Workers Comp
O
37.84
9.74
15.47
67.61
17.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
EPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
HMO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
Medicaid
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
Medicare Part A
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
Medicare Part B
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
POS
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
PPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
aetna - medicare advantage
Workers Comp
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
EPO
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
HMO
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
Medicaid
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
Medicare Part A
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
Medicare Part B
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
POS
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
PPO
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield
Workers Comp
O
52.31
8.21
8.21
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
EPO
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
HMO
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
Medicaid
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
Medicare Part A
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
Medicare Part B
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
POS
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
PPO
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
blue cross blue shield - medicare advantage
Workers Comp
O
52.31
8.21
9.49
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
EPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
HMO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
Medicaid
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
Medicare Part A
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
Medicare Part B
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
POS
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
PPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
humana - medicare advantage
Workers Comp
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
EPO
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
HMO
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
Medicaid
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
Medicare Part A
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
Medicare Part B
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
POS
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
PPO
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
tricare
Workers Comp
O
52.31
8.21
11.59
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
EPO
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
HMO
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
Medicaid
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
Medicare Part A
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
Medicare Part B
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
POS
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
PPO
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
united healthcare
Workers Comp
O
52.31
8.21
37.36
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
EPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
HMO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
Medicaid
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
Medicare Part A
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
Medicare Part B
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
POS
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
PPO
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86403
null
cpt
Screening test for presence of antibody
va
Workers Comp
O
52.31
8.21
11.54
37.36
13.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
EPO
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
HMO
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
Medicaid
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
Medicare Part A
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
Medicare Part B
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
POS
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
PPO
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna
Workers Comp
O
40.17
3.70
23.30
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
EPO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
HMO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
Medicaid
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
Medicare Part A
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
Medicare Part B
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
POS
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
PPO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
aetna - medicare advantage
Workers Comp
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
EPO
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
HMO
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
Medicaid
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
Medicare Part A
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
Medicare Part B
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
POS
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
PPO
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield
Workers Comp
O
40.17
3.70
6.40
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
EPO
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
HMO
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
Medicaid
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
Medicare Part A
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
Medicare Part B
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
POS
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
PPO
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
blue cross blue shield - medicare advantage
Workers Comp
O
40.17
3.70
7.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
EPO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
HMO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
Medicaid
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
Medicare Part A
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
Medicare Part B
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
POS
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
PPO
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
humana - medicare advantage
Workers Comp
O
40.17
3.70
6.14
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
EPO
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
HMO
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
Medicaid
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
Medicare Part A
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
Medicare Part B
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
POS
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
PPO
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
tricare
Workers Comp
O
40.17
3.70
6.17
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
EPO
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
HMO
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
Medicaid
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
Medicare Part A
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
Medicare Part B
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
POS
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
PPO
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare
Workers Comp
O
40.17
3.70
28.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
EPO
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
HMO
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
Medicaid
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
Medicare Part A
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
Medicare Part B
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
POS
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
PPO
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
united healthcare - medicare advantage
Workers Comp
O
40.17
3.70
6.19
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
EPO
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
HMO
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
Medicaid
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
Medicare Part A
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
Medicare Part B
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
POS
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
PPO
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86430
null
cpt
Rheumatoid factor analysis
va
Workers Comp
O
40.17
3.70
3.70
28.70
7.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
EPO
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
HMO
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
Medicaid
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
Medicare Part A
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
Medicare Part B
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
POS
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
PPO
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna
Workers Comp
O
330.56
35.31
188.73
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
EPO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
HMO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
Medicaid
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
Medicare Part A
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
Medicare Part B
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
POS
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
PPO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
aetna - medicare advantage
Workers Comp
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
EPO
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
HMO
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
Medicaid
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
Medicare Part A
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
Medicare Part B
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
POS
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
PPO
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield
Workers Comp
O
330.56
35.31
37.63
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
EPO
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
HMO
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
Medicaid
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
Medicare Part A
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
Medicare Part B
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
POS
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
PPO
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
blue cross blue shield - medicare advantage
Workers Comp
O
330.56
35.31
35.31
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
EPO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
HMO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
Medicaid
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
Medicare Part A
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
Medicare Part B
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
POS
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
PPO
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
humana - medicare advantage
Workers Comp
O
330.56
35.31
61.98
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
EPO
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
HMO
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
Medicaid
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
Medicare Part A
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
Medicare Part B
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
POS
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
PPO
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
tricare
Workers Comp
O
330.56
35.31
62.23
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
EPO
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
HMO
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
Medicaid
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
Medicare Part A
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
Medicare Part B
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
POS
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
PPO
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
united healthcare
Workers Comp
O
330.56
35.31
236.12
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
EPO
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
HMO
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
Medicaid
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
Medicare Part A
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
Medicare Part B
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
POS
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
PPO
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86480
null
cpt
Tuberculosis test gamma interferon
va
Workers Comp
O
330.56
35.31
51.74
236.12
74.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
EPO
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
HMO
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
Medicaid
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
Medicare Part A
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
Medicare Part B
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
POS
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
PPO
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna
Workers Comp
O
37.84
4.27
21.95
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
EPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
HMO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
Medicaid
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
Medicare Part A
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
Medicare Part B
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
POS
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
PPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
aetna - medicare advantage
Workers Comp
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
EPO
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
HMO
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
Medicaid
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
Medicare Part A
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
Medicare Part B
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
POS
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
PPO
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield
Workers Comp
O
37.84
4.27
6.32
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
EPO
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
HMO
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
Medicaid
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
Medicare Part A
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
Medicare Part B
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
POS
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
PPO
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
blue cross blue shield - medicare advantage
Workers Comp
O
37.84
4.27
5.46
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
EPO
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
HMO
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
Medicaid
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
Medicare Part A
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
Medicare Part B
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
POS
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
PPO
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
cigna
Workers Comp
O
37.84
4.27
26.78
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
EPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
HMO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
Medicaid
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
Medicare Part A
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
Medicare Part B
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
POS
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
PPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
humana - medicare advantage
Workers Comp
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
EPO
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
HMO
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
Medicaid
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
Medicare Part A
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
Medicare Part B
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
POS
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
PPO
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
medica
Workers Comp
O
37.84
4.27
14.00
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
EPO
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
HMO
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
Medicaid
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
Medicare Part A
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
Medicare Part B
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
POS
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
PPO
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
tricare
Workers Comp
O
37.84
4.27
4.29
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
EPO
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
HMO
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
Medicaid
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
Medicare Part A
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
Medicare Part B
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
POS
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
PPO
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
united healthcare
Workers Comp
O
37.84
4.27
27.03
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
EPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
HMO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
Medicaid
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
Medicare Part A
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
Medicare Part B
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
POS
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
PPO
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
va
Workers Comp
O
37.84
4.27
4.27
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
EPO
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
HMO
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
Medicaid
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
Medicare Part A
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
Medicare Part B
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
POS
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
PPO
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86592
null
cpt
Syphilis detection test
webtpa
Workers Comp
O
37.84
4.27
25.23
27.03
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
EPO
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
HMO
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
Medicaid
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
Medicare Part A
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
Medicare Part B
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
POS
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
PPO
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
blue cross blue shield
Workers Comp
O
47.18
4.67
7.75
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
EPO
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
HMO
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
Medicaid
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
Medicare Part A
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
Medicare Part B
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
POS
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
PPO
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86593
null
cpt
Syphilis test
tricare
Workers Comp
O
47.18
4.67
4.67
7.75
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
EPO
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
HMO
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
Medicaid
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
Medicare Part A
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
Medicare Part B
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
POS
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
PPO
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
866
null
ms-drg
viral illness without mcc
tricare
Workers Comp
I
15755.53
4294.18
4294.18
4294.18
9453.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
EPO
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
HMO
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
Medicaid
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
Medicare Part A
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
Medicare Part B
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
POS
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
PPO
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86606
null
cpt
Analysis for antibody to aspergillus (fungus)
blue cross blue shield - medicare advantage
Workers Comp
O
37.63
16.25
16.25
16.25
22.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
EPO
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
HMO
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
Medicaid
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
Medicare Part A
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
Medicare Part B
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
POS
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
PPO
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86609
null
cpt
Analysis for antibody bacteria
blue cross blue shield - medicare advantage
Workers Comp
O
32.20
13.90
13.90
13.90
19.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
EPO
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
HMO
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
Medicaid
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
Medicare Part A
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
Medicare Part B
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
POS
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
PPO
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86612
null
cpt
Analysis for antibody to blastomyces (fungus)
blue cross blue shield
Workers Comp
O
32.25
5.08
5.08
5.08
19.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
EPO
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
HMO
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicaid
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicare Part A
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicare Part B
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
POS
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
PPO
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86617
null
cpt
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Workers Comp
O
33.39
8.52
8.52
8.52
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
EPO
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
HMO
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicaid
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicare Part A
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Medicare Part B
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
POS
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
PPO
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield
Workers Comp
O
254.40
17.03
48.30
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
EPO
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
HMO
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
Medicaid
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
Medicare Part A
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
Medicare Part B
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
POS
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
PPO
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
blue cross blue shield - medicare advantage
Workers Comp
O
254.40
17.03
40.20
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
EPO
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
HMO
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
Medicaid
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
Medicare Part A
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
Medicare Part B
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
POS
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
PPO
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
humana - medicare advantage
Workers Comp
O
254.40
17.03
17.03
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
EPO
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
HMO
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
Medicaid
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
Medicare Part A
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
Medicare Part B
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
POS
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
PPO
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
tricare
Workers Comp
O
254.40
17.03
17.10
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
EPO
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
HMO
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
Medicaid
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
Medicare Part A
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
Medicare Part B
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
POS
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
PPO
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86618
null
cpt
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)
united healthcare
Workers Comp
O
254.40
17.03
190.80
190.80
152.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
EPO
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
HMO
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
Medicaid
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
Medicare Part A
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
Medicare Part B
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
POS
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
PPO
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86635
null
cpt
Analysis for antibody to Coccidioides (bacteria)
blue cross blue shield
Workers Comp
O
85.83
16.60
16.60
16.60
51.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
EPO
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
HMO
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
Medicaid
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
Medicare Part A
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
Medicare Part B
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
POS
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
PPO
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86638
null
cpt
Analysis for antibody to Coxiella burnetii (Q fever bacteria)
blue cross blue shield - medicare advantage
Workers Comp
O
30.30
13.56
13.56
13.56
18.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
EPO
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
HMO
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
Medicaid
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
Medicare Part A
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
Medicare Part B
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
POS
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
PPO
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
aetna
Workers Comp
O
74.57
14.45
20.87
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
EPO
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
HMO
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
Medicaid
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
Medicare Part A
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
Medicare Part B
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
POS
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
PPO
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
blue cross blue shield
Workers Comp
O
74.57
14.45
23.13
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
EPO
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
HMO
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
Medicaid
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
Medicare Part A
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
Medicare Part B
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
POS
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
PPO
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86644
null
cpt
Analysis for antibody to Cytomegalovirus (CMV)
tricare
Workers Comp
O
74.57
14.45
14.45
23.13
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
EPO
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
HMO
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
Medicaid
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
Medicare Part A
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
Medicare Part B
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
POS
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
PPO
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
blue cross blue shield
Workers Comp
O
67.89
16.92
21.06
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
EPO
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
HMO
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
Medicaid
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
Medicare Part A
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
Medicare Part B
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
POS
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
PPO
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86645
null
cpt
Analysis for antibody (IgM) to Cytomegalovirus (CMV)
tricare
Workers Comp
O
67.89
16.92
16.92
21.06
40.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
EPO
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
HMO
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
Medicaid
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
Medicare Part A
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
Medicare Part B
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
POS
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
PPO
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86664
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) nuclear antigen
tricare
Workers Comp
O
251.53
15.35
15.35
15.35
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
EPO
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
HMO
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
Medicaid
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
Medicare Part A
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
Medicare Part B
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
POS
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
PPO
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86665
null
cpt
Analysis for antibody to Epstein-Barr virus (mononucleosis virus) viral capsid
tricare
Workers Comp
O
251.53
18.21
18.21
18.21
150.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
EPO
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
HMO
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
Medicaid
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
Medicare Part A
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
Medicare Part B
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
POS
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
PPO
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
blue cross blue shield - medicare advantage
Workers Comp
O
30.63
4.64
4.64
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
EPO
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
HMO
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
Medicaid
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
Medicare Part A
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
Medicare Part B
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
POS
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
PPO
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86671
null
cpt
Analysis for antibody to fungus
tricare
Workers Comp
O
30.63
4.64
12.30
12.30
18.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
EPO
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
HMO
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
Medicaid
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
Medicare Part A
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
Medicare Part B
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
POS
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
PPO
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86692
null
cpt
Analysis for antibody to Hepatitis D virus
blue cross blue shield - medicare advantage
Workers Comp
O
42.90
10.68
10.68
10.68
25.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
EPO
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
HMO
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
Medicaid
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
Medicare Part A
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
Medicare Part B
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
POS
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
PPO
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
aetna
Workers Comp
O
84.58
12.55
49.90
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
EPO
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
HMO
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
Medicaid
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
Medicare Part A
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
Medicare Part B
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
POS
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
PPO
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield
Workers Comp
O
84.58
12.55
14.11
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
EPO
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
HMO
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
Medicaid
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
Medicare Part A
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
Medicare Part B
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
POS
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
PPO
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
blue cross blue shield - medicare advantage
Workers Comp
O
84.58
12.55
12.55
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
EPO
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
HMO
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
Medicaid
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
Medicare Part A
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
Medicare Part B
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
POS
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
PPO
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
humana - medicare advantage
Workers Comp
O
84.58
12.55
13.19
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
EPO
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
HMO
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
Medicaid
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
Medicare Part A
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
Medicare Part B
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
POS
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
PPO
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
tricare
Workers Comp
O
84.58
12.55
13.24
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
EPO
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
HMO
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
Medicaid
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
Medicare Part A
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
Medicare Part B
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
POS
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
PPO
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
united healthcare
Workers Comp
O
84.58
12.55
55.40
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
EPO
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
HMO
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
Medicaid
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
Medicare Part A
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
Medicare Part B
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
POS
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
PPO
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86695
null
cpt
Analysis for antibody to Herpes simplex virus type 1
webtpa
Workers Comp
O
84.58
12.55
56.39
56.39
15.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
EPO
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
HMO
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
Medicaid
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
Medicare Part A
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
Medicare Part B
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
POS
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
PPO
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
aetna
Workers Comp
O
119.09
17.66
70.26
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
EPO
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
HMO
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
Medicaid
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
Medicare Part A
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
Medicare Part B
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
POS
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
PPO
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield
Workers Comp
O
119.09
17.66
19.87
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
EPO
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
HMO
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
Medicaid
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
Medicare Part A
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
Medicare Part B
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
POS
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
PPO
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
blue cross blue shield - medicare advantage
Workers Comp
O
119.09
17.66
17.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
EPO
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
HMO
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
Medicaid
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
Medicare Part A
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
Medicare Part B
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
POS
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
PPO
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
humana - medicare advantage
Workers Comp
O
119.09
17.66
19.35
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
EPO
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
HMO
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
Medicaid
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
Medicare Part A
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
Medicare Part B
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
POS
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
PPO
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
tricare
Workers Comp
O
119.09
17.66
19.43
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
EPO
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
HMO
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
Medicaid
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
Medicare Part A
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
Medicare Part B
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
POS
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
PPO
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
united healthcare
Workers Comp
O
119.09
17.66
204.66
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
EPO
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
HMO
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
Medicaid
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
Medicare Part A
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
Medicare Part B
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
POS
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
PPO
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86696
null
cpt
Analysis for antibody to Herpes simplex virus type 2
webtpa
Workers Comp
O
119.09
17.66
79.40
204.66
23.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
EPO
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
HMO
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
Medicaid
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
Medicare Part A
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
Medicare Part B
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
POS
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
PPO
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86698
null
cpt
Analysis for antibody to histoplasma (fungus)
blue cross blue shield
Workers Comp
O
109.92
22.57
22.57
22.57
65.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
EPO
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
HMO
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
Medicaid
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
Medicare Part A
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
Medicare Part B
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
POS
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
PPO
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield
Workers Comp
O
166.39
12.05
18.08
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
EPO
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
HMO
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
POS
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
PPO
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
166.39
12.05
20.33
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
EPO
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
HMO
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
Medicaid
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
Medicare Part A
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
Medicare Part B
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
POS
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
PPO
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
humana - medicare advantage
Workers Comp
O
166.39
12.05
12.05
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
EPO
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
HMO
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
Medicaid
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
Medicare Part A
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
Medicare Part B
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
POS
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
PPO
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86704
null
cpt
Hepatitis B core antibody measurement
united healthcare
Workers Comp
O
166.39
12.05
118.85
118.85
99.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
EPO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
HMO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
Medicaid
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
Medicare Part A
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
Medicare Part B
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
POS
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
PPO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
aetna - medicare advantage
Workers Comp
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
EPO
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
HMO
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
Medicaid
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
Medicare Part A
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
Medicare Part B
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
POS
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
PPO
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield
Workers Comp
O
94.37
9.43
10.18
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
EPO
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
HMO
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
Medicaid
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
POS
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
PPO
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
blue cross blue shield - medicare advantage
Workers Comp
O
94.37
9.43
18.87
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
EPO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
HMO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
Medicaid
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
Medicare Part A
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
Medicare Part B
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
POS
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
PPO
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
humana - medicare advantage
Workers Comp
O
94.37
9.43
11.77
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
EPO
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
HMO
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
Medicaid
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
Medicare Part A
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
Medicare Part B
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
POS
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
PPO
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
tricare
Workers Comp
O
94.37
9.43
11.82
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
EPO
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
HMO
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
Medicaid
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
Medicare Part A
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
Medicare Part B
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
POS
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
PPO
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86705
null
cpt
Hepatitis B core antibody (IgM) measurement
va
Workers Comp
O
94.37
9.43
9.43
18.87
14.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
EPO
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
HMO
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
Medicaid
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
Medicare Part A
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
Medicare Part B
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
POS
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
PPO
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna
Workers Comp
O
89.04
10.74
51.64
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
EPO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
HMO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
Medicaid
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
Medicare Part A
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
Medicare Part B
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
POS
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
PPO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
aetna - medicare advantage
Workers Comp
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
EPO
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
HMO
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
Medicaid
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
Medicare Part A
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
Medicare Part B
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
POS
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
PPO
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield
Workers Comp
O
89.04
10.74
14.52
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
EPO
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
HMO
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
POS
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
PPO
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
89.04
10.74
13.19
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
EPO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
HMO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
Medicaid
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
Medicare Part A
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
Medicare Part B
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
POS
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
PPO
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
humana - medicare advantage
Workers Comp
O
89.04
10.74
10.74
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
EPO
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
HMO
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
Medicaid
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
Medicare Part A
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
Medicare Part B
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
POS
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
PPO
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
tricare
Workers Comp
O
89.04
10.74
10.78
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
EPO
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
HMO
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
Medicaid
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
Medicare Part A
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
Medicare Part B
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
POS
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
PPO
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
united healthcare
Workers Comp
O
89.04
10.74
63.60
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
EPO
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
HMO
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
Medicaid
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
Medicare Part A
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
Medicare Part B
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
POS
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
PPO
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86706
null
cpt
Hepatitis B surface antibody measurement
webtpa
Workers Comp
O
89.04
10.74
60.85
63.60
12.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
EPO
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
HMO
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
POS
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
PPO
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
28.93
5.97
5.97
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
EPO
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
HMO
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
Medicaid
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
Medicare Part A
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
Medicare Part B
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
POS
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
PPO
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86707
null
cpt
Hepatitis Be antibody measurement
humana - medicare advantage
Workers Comp
O
28.93
5.97
11.57
11.57
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
EPO
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
HMO
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
Medicaid
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
Medicare Part A
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
Medicare Part B
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
POS
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
PPO
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86708
null
cpt
Measurement of Hepatitis A antibody
blue cross blue shield - medicare advantage
Workers Comp
O
30.98
3.30
3.30
3.30
18.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
EPO
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
HMO
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
Medicaid
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
Medicare Part A
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
Medicare Part B
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
POS
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
PPO
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
aetna
Workers Comp
O
100.27
11.26
59.37
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
EPO
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
HMO
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
Medicaid
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
Medicare Part A
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
Medicare Part B
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
POS
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
PPO
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86709
null
cpt
Measurement of Hepatitis A antibody (IgM)
humana - medicare advantage
Workers Comp
O
100.27
11.26
11.26
59.37
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
EPO
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
HMO
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
Medicaid
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
Medicare Part A
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
Medicare Part B
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
POS
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
PPO
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
aetna
Workers Comp
O
47.18
6.97
27.36
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
EPO
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
HMO
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
Medicaid
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
Medicare Part A
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
Medicare Part B
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
POS
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
PPO
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield
Workers Comp
O
47.18
6.97
8.41
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
EPO
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
HMO
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
Medicaid
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
Medicare Part A
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
Medicare Part B
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
POS
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
PPO
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
blue cross blue shield - medicare advantage
Workers Comp
O
47.18
6.97
6.97
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
EPO
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
HMO
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
Medicaid
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
Medicare Part A
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
Medicare Part B
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
POS
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
PPO
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86735
null
cpt
Analysis for antibody to mumps virus
tricare
Workers Comp
O
47.18
6.97
13.10
27.36
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
EPO
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
HMO
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
Medicaid
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
Medicare Part A
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
Medicare Part B
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
POS
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
PPO
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
blue cross blue shield
Workers Comp
O
65.19
15.09
28.98
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
EPO
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
HMO
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
Medicaid
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
Medicare Part A
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
Medicare Part B
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
POS
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
PPO
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
tricare
Workers Comp
O
65.19
15.09
15.09
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
EPO
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
HMO
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
Medicaid
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
Medicare Part A
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
Medicare Part B
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
POS
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
PPO
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86747
null
cpt
Analysis for antibody to parvovirus
united healthcare
Workers Comp
O
65.19
15.09
47.70
47.70
39.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
EPO
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
HMO
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
Medicaid
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
Medicare Part A
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
Medicare Part B
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
POS
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
PPO
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
aetna
Workers Comp
O
47.18
6.56
27.36
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
EPO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
HMO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
Medicaid
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
Medicare Part A
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
Medicare Part B
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
POS
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
PPO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield
Workers Comp
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
EPO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
HMO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
Medicaid
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
Medicare Part A
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
Medicare Part B
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
POS
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
PPO
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
blue cross blue shield - medicare advantage
Workers Comp
O
47.18
6.56
6.56
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
EPO
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
HMO
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
Medicaid
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
Medicare Part A
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
Medicare Part B
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
POS
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
PPO
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
cigna
Workers Comp
O
47.18
6.56
33.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
EPO
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
HMO
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
Medicaid
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
Medicare Part A
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
Medicare Part B
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
POS
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
PPO
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
humana - medicare advantage
Workers Comp
O
47.18
6.56
44.94
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
EPO
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
HMO
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
Medicaid
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
Medicare Part A
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
Medicare Part B
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
POS
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
PPO
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
tricare
Workers Comp
O
47.18
6.56
16.06
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
EPO
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
HMO
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
Medicaid
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
Medicare Part A
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
Medicare Part B
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
POS
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
PPO
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
united healthcare
Workers Comp
O
47.18
6.56
33.71
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
EPO
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
HMO
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
Medicaid
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
Medicare Part A
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
Medicare Part B
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
POS
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
PPO
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
va
Workers Comp
O
47.18
6.56
14.39
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
EPO
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
HMO
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
Medicaid
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
Medicare Part A
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
Medicare Part B
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
POS
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
PPO
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86762
null
cpt
Analysis for antibody to Rubella (German measles virus)
webtpa
Workers Comp
O
47.18
6.56
33.03
44.94
17.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
EPO
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
HMO
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
Medicaid
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
Medicare Part A
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
Medicare Part B
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
POS
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
PPO
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
aetna
Workers Comp
O
47.18
11.12
55.32
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
EPO
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
HMO
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
Medicaid
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
Medicare Part A
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
Medicare Part B
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
POS
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
PPO
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield
Workers Comp
O
47.18
11.12
11.12
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
EPO
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
HMO
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
Medicaid
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
Medicare Part A
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
Medicare Part B
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
POS
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
PPO
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
blue cross blue shield - medicare advantage
Workers Comp
O
47.18
11.12
12.04
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
EPO
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
HMO
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
Medicaid
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
Medicare Part A
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
Medicare Part B
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
POS
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
PPO
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
tricare
Workers Comp
O
47.18
11.12
12.93
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
EPO
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
HMO
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
Medicaid
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
Medicare Part A
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
Medicare Part B
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
POS
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
PPO
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86765
null
cpt
Analysis for antibody to Rubeola (measles virus)
webtpa
Workers Comp
O
47.18
11.12
100.50
100.50
28.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
EPO
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
HMO
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
Medicaid
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
Medicare Part A
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
Medicare Part B
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
POS
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
PPO
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna
Workers Comp
O
89.25
18.64
50.96
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
EPO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
HMO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
Medicaid
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
Medicare Part A
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
Medicare Part B
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
POS
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
PPO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
aetna - medicare advantage
Workers Comp
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
EPO
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
HMO
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
Medicaid
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
Medicare Part A
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
Medicare Part B
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
POS
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
PPO
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield
Workers Comp
O
89.25
18.64
18.64
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
EPO
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
HMO
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
Medicaid
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
Medicare Part A
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
Medicare Part B
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
POS
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
PPO
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
blue cross blue shield - medicare advantage
Workers Comp
O
89.25
18.64
20.83
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
EPO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
HMO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
Medicaid
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
Medicare Part A
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
Medicare Part B
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
POS
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
PPO
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
humana - medicare advantage
Workers Comp
O
89.25
18.64
42.13
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
EPO
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
HMO
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
Medicaid
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
Medicare Part A
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
Medicare Part B
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
POS
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
PPO
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
tricare
Workers Comp
O
89.25
18.64
42.30
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
EPO
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
HMO
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
Medicaid
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
Medicare Part A
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
Medicare Part B
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
POS
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
PPO
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86769
null
cpt
SARS-COV-2 COVID-19 ANTIBODY
webtpa
Workers Comp
O
89.25
18.64
62.48
62.48
50.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
EPO
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
HMO
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
Medicaid
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
Medicare Part A
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
Medicare Part B
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
POS
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
PPO
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
aetna
Workers Comp
O
143.57
14.45
85.01
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
EPO
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
HMO
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicaid
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicare Part A
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicare Part B
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
POS
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
PPO
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Workers Comp
O
143.57
14.45
14.53
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
EPO
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
HMO
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
Medicaid
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
Medicare Part A
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
Medicare Part B
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
POS
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
PPO
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86777
null
cpt
Analysis for antibody to Toxoplasma (parasite)
tricare
Workers Comp
O
143.57
14.45
14.45
85.01
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
EPO
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
HMO
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
Medicaid
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
Medicare Part A
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
Medicare Part B
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
POS
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
PPO
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
aetna
Workers Comp
O
143.57
14.47
86.74
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
EPO
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
HMO
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicaid
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicare Part A
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Medicare Part B
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
POS
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
PPO
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
blue cross blue shield - medicare advantage
Workers Comp
O
143.57
14.47
14.54
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
EPO
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
HMO
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
Medicaid
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
Medicare Part A
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
Medicare Part B
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
POS
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
PPO
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86778
null
cpt
Analysis for antibody (IgM) to Toxoplasma (parasite)
tricare
Workers Comp
O
143.57
14.47
14.47
86.74
86.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
EPO
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
HMO
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
Medicaid
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
Medicare Part A
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
Medicare Part B
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
POS
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
PPO
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
blue cross blue shield
Workers Comp
O
312.75
13.29
43.03
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
EPO
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
HMO
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
Medicaid
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
Medicare Part A
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
Medicare Part B
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
POS
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
PPO
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86780
null
cpt
Analysis for antibody Treponema pallidum
tricare
Workers Comp
O
312.75
13.29
13.29
43.03
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
EPO
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
HMO
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
Medicaid
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
Medicare Part A
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
Medicare Part B
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
POS
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
PPO
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
aetna
Workers Comp
O
50.08
6.72
29.05
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
EPO
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
HMO
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
Medicaid
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
Medicare Part A
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
Medicare Part B
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
POS
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
PPO
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield
Workers Comp
O
50.08
6.72
7.37
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
EPO
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
HMO
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
Medicaid
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
Medicare Part A
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
Medicare Part B
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
POS
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
PPO
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
blue cross blue shield - medicare advantage
Workers Comp
O
50.08
6.72
6.72
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
EPO
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
HMO
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
Medicaid
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
Medicare Part A
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
Medicare Part B
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
POS
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
PPO
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
cigna
Workers Comp
O
50.08
6.72
34.44
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
EPO
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
HMO
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
Medicaid
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
Medicare Part A
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
Medicare Part B
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
POS
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
PPO
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
humana - medicare advantage
Workers Comp
O
50.08
6.72
12.88
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
EPO
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
HMO
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
Medicaid
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
Medicare Part A
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
Medicare Part B
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
POS
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
PPO
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
tricare
Workers Comp
O
50.08
6.72
12.93
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
EPO
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
HMO
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
Medicaid
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
Medicare Part A
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
Medicare Part B
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
POS
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
PPO
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
united healthcare
Workers Comp
O
50.08
6.72
35.78
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
EPO
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
HMO
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
Medicaid
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
Medicare Part A
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
Medicare Part B
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
POS
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
PPO
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86787
null
cpt
Analysis for antibody to varicella-zoster virus (chicken pox)
webtpa
Workers Comp
O
50.08
6.72
33.39
35.78
15.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
EPO
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
HMO
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
Medicaid
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
Medicare Part A
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
Medicare Part B
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
POS
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
PPO
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
aetna
Workers Comp
O
67.89
14.25
38.77
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
EPO
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
HMO
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
Medicaid
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
Medicare Part A
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
Medicare Part B
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
POS
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
PPO
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield
Workers Comp
O
67.89
14.25
14.25
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
EPO
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
HMO
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
POS
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
PPO
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
14.25
17.60
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
EPO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
HMO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
Medicaid
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
Medicare Part A
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
Medicare Part B
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
POS
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
PPO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
humana - medicare advantage
Workers Comp
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
EPO
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
HMO
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
Medicaid
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
Medicare Part A
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
Medicare Part B
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
POS
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
PPO
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
tricare
Workers Comp
O
67.89
14.25
15.98
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
EPO
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
HMO
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
Medicaid
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
Medicare Part A
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
Medicare Part B
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
POS
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
PPO
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
united healthcare
Workers Comp
O
67.89
14.25
50.92
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
EPO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
HMO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
Medicaid
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
Medicare Part A
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
Medicare Part B
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
POS
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
PPO
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86800
null
cpt
Thyroglobulin (thyroid protein) antibody measurement
va
Workers Comp
O
67.89
14.25
15.91
50.92
19.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
EPO
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
HMO
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
Medicaid
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
Medicare Part A
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
Medicare Part B
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
POS
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
PPO
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
aetna
Workers Comp
O
106.84
14.27
64.55
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
EPO
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
HMO
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
Medicaid
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
Medicare Part A
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
Medicare Part B
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
POS
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
PPO
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield
Workers Comp
O
106.84
14.27
19.80
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
EPO
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
HMO
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
Medicaid
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
Medicare Part A
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
Medicare Part B
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
POS
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
PPO
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
blue cross blue shield - medicare advantage
Workers Comp
O
106.84
14.27
19.51
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
EPO
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
HMO
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
Medicaid
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
Medicare Part A
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
Medicare Part B
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
POS
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
PPO
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
cigna
Workers Comp
O
106.84
14.27
75.61
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
EPO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
HMO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
Medicaid
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
Medicare Part A
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
Medicare Part B
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
POS
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
PPO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
humana - medicare advantage
Workers Comp
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
EPO
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
HMO
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
Medicaid
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
Medicare Part A
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
Medicare Part B
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
POS
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
PPO
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
tricare
Workers Comp
O
106.84
14.27
14.33
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
EPO
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
HMO
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
Medicaid
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
Medicare Part A
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
Medicare Part B
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
POS
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
PPO
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
united healthcare
Workers Comp
O
106.84
14.27
76.32
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
EPO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
HMO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
Medicaid
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
Medicare Part A
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
Medicare Part B
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
POS
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
PPO
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
va
Workers Comp
O
106.84
14.27
14.27
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
EPO
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
HMO
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
Medicaid
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
Medicare Part A
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
Medicare Part B
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
POS
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
PPO
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86803
null
cpt
Hepatitis C antibody measurement
webtpa
Workers Comp
O
106.84
14.27
71.23
76.32
17.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
EPO
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
HMO
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
Medicaid
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
Medicare Part A
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
Medicare Part B
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
POS
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
PPO
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
aetna - medicare advantage
Workers Comp
O
95.71
17.79
25.81
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
EPO
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
HMO
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
Medicaid
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
Medicare Part A
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
Medicare Part B
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
POS
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
PPO
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield
Workers Comp
O
95.71
17.79
17.79
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
EPO
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
HMO
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
Medicaid
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
POS
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
PPO
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
17.79
20.62
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
EPO
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
HMO
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
Medicaid
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
Medicare Part A
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
Medicare Part B
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
POS
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
PPO
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
cigna
Workers Comp
O
95.71
17.79
63.90
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
EPO
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
HMO
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
Medicaid
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
Medicare Part A
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
Medicare Part B
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
POS
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
PPO
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
tricare
Workers Comp
O
95.71
17.79
25.92
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
EPO
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
HMO
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
Medicaid
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
Medicare Part A
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
Medicare Part B
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
POS
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
PPO
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86812
null
cpt
Immunologic analysis for autoimmune disease A B or C single antigen
united healthcare
Workers Comp
O
95.71
17.79
68.37
68.37
57.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
EPO
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
HMO
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
Medicaid
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
Medicare Part A
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
Medicare Part B
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
POS
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
PPO
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
aetna
Workers Comp
O
87.92
13.74
50.99
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
EPO
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
HMO
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
Medicaid
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
Medicare Part A
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
Medicare Part B
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
POS
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
PPO
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield
Workers Comp
O
87.92
13.74
13.78
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
EPO
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
HMO
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
Medicaid
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
POS
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
PPO
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
13.74
13.74
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
EPO
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
HMO
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
Medicaid
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
Medicare Part A
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
Medicare Part B
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
POS
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
PPO
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
cigna
Workers Comp
O
87.92
13.74
60.46
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
EPO
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
HMO
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
Medicaid
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
Medicare Part A
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
Medicare Part B
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
POS
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
PPO
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
humana - medicare advantage
Workers Comp
O
87.92
13.74
63.91
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
EPO
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
HMO
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
Medicaid
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
Medicare Part A
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
Medicare Part B
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
POS
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
PPO
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
tricare
Workers Comp
O
87.92
13.74
43.82
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
EPO
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
HMO
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
Medicaid
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
Medicare Part A
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
Medicare Part B
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
POS
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
PPO
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
united healthcare
Workers Comp
O
87.92
13.74
62.81
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
EPO
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
HMO
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
Medicaid
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
Medicare Part A
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
Medicare Part B
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
POS
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
PPO
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86850
null
cpt
Screening test for red blood cell antibodies
va
Workers Comp
O
87.92
13.74
90.14
90.14
52.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
EPO
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
HMO
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
Medicaid
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
Medicare Part A
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
Medicare Part B
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
POS
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
PPO
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield
Workers Comp
O
286.04
11.16
36.47
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
EPO
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
HMO
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
Medicaid
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part A
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
Medicare Part B
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
POS
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
PPO
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
blue cross blue shield - medicare advantage
Workers Comp
O
286.04
11.16
11.16
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
EPO
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
HMO
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
Medicaid
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
Medicare Part A
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
Medicare Part B
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
POS
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
PPO
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
humana - medicare advantage
Workers Comp
O
286.04
11.16
257.95
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
EPO
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
HMO
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
Medicaid
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
Medicare Part A
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
Medicare Part B
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
POS
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
PPO
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86870
null
cpt
Identification of red blood cell antibodies
tricare
Workers Comp
O
286.04
11.16
251.07
257.95
301.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
EPO
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
HMO
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
Medicaid
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
Medicare Part A
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
Medicare Part B
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
POS
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
PPO
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield
Workers Comp
O
416.26
29.61
44.64
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
EPO
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
HMO
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
Medicaid
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
Medicare Part A
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
Medicare Part B
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
POS
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
PPO
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
blue cross blue shield - medicare advantage
Workers Comp
O
416.26
29.61
54.06
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
EPO
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
HMO
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
Medicaid
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
Medicare Part A
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
Medicare Part B
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
POS
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
PPO
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
humana - medicare advantage
Workers Comp
O
416.26
29.61
29.61
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
EPO
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
HMO
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
Medicaid
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
Medicare Part A
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
Medicare Part B
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
POS
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
PPO
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
tricare
Workers Comp
O
416.26
29.61
39.45
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
EPO
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
HMO
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
Medicaid
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
Medicare Part A
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
Medicare Part B
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
POS
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
PPO
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86880
null
cpt
Red blood cell antibody detection test direct
united healthcare
Workers Comp
O
416.26
29.61
297.33
297.33
35.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
EPO
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
HMO
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
Medicaid
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
Medicare Part A
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
Medicare Part B
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
POS
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
PPO
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
aetna
Workers Comp
O
119.09
17.83
69.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
EPO
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
HMO
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
Medicaid
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
Medicare Part A
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
Medicare Part B
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
POS
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
PPO
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield
Workers Comp
O
119.09
17.83
17.83
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
EPO
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
HMO
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
Medicaid
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
Medicare Part A
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
Medicare Part B
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
POS
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
PPO
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
blue cross blue shield - medicare advantage
Workers Comp
O
119.09
17.83
18.31
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
EPO
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
HMO
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
Medicaid
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
Medicare Part A
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
Medicare Part B
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
POS
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
PPO
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
cigna
Workers Comp
O
119.09
17.83
76.69
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
EPO
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
HMO
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
Medicaid
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
Medicare Part A
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
Medicare Part B
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
POS
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
PPO
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
humana - medicare advantage
Workers Comp
O
119.09
17.83
99.15
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
EPO
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
HMO
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
Medicaid
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
Medicare Part A
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
Medicare Part B
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
POS
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
PPO
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
tricare
Workers Comp
O
119.09
17.83
96.59
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
EPO
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
HMO
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
Medicaid
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
Medicare Part A
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
Medicare Part B
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
POS
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
PPO
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
united healthcare
Workers Comp
O
119.09
17.83
85.07
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
EPO
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
HMO
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
Medicaid
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
Medicare Part A
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
Medicare Part B
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
POS
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
PPO
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86900
null
cpt
Blood group typing (ABO)
va
Workers Comp
O
119.09
17.83
99.14
99.15
115.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
EPO
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
HMO
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
Medicaid
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
Medicare Part A
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
Medicare Part B
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
POS
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
PPO
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
aetna
Workers Comp
O
79.02
11.83
45.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
EPO
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
HMO
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
Medicaid
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
Medicare Part A
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
Medicare Part B
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
POS
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
PPO
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield
Workers Comp
O
79.02
11.83
11.83
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
EPO
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
HMO
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
Medicaid
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
Medicare Part A
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
Medicare Part B
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
POS
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
PPO
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
blue cross blue shield - medicare advantage
Workers Comp
O
79.02
11.83
12.05
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
EPO
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
HMO
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
Medicaid
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
Medicare Part A
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
Medicare Part B
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
POS
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
PPO
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
cigna
Workers Comp
O
79.02
11.83
50.89
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
EPO
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
HMO
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
Medicaid
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
Medicare Part A
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
Medicare Part B
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
POS
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
PPO
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
humana - medicare advantage
Workers Comp
O
79.02
11.83
75.26
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
EPO
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
HMO
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
Medicaid
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
Medicare Part A
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
Medicare Part B
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
POS
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
PPO
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
tricare
Workers Comp
O
79.02
11.83
53.36
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
EPO
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
HMO
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
Medicaid
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
Medicare Part A
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
Medicare Part B
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
POS
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
PPO
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
united healthcare
Workers Comp
O
79.02
11.83
56.45
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
EPO
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
HMO
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
Medicaid
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
Medicare Part A
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
Medicare Part B
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
POS
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
PPO
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86901
null
cpt
Blood typing for Rh (D) antigen
va
Workers Comp
O
79.02
11.83
79.02
79.02
19.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
EPO
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
HMO
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
Medicaid
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
Medicare Part A
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
Medicare Part B
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
POS
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
PPO
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86905
null
cpt
Blood typing for red blood cell antigens
blue cross blue shield
Workers Comp
O
461.75
169.00
169.00
169.00
277.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
EPO
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
HMO
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
Medicaid
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
Medicare Part A
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
Medicare Part B
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
POS
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
PPO
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
aetna - medicare advantage
Workers Comp
O
352.82
33.03
129.61
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
EPO
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
HMO
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
Medicaid
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
Medicare Part A
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
Medicare Part B
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
POS
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
PPO
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield
Workers Comp
O
352.82
33.03
47.29
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
EPO
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
HMO
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
Medicaid
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
Medicare Part A
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
Medicare Part B
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
POS
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
PPO
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
blue cross blue shield - medicare advantage
Workers Comp
O
352.82
33.03
231.69
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
EPO
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
HMO
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
Medicaid
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
Medicare Part A
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
Medicare Part B
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
POS
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
PPO
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
humana - medicare advantage
Workers Comp
O
352.82
33.03
62.74
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
EPO
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
HMO
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
Medicaid
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
Medicare Part A
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
Medicare Part B
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
POS
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
PPO
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
tricare
Workers Comp
O
352.82
33.03
33.03
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
EPO
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
HMO
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
Medicaid
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
Medicare Part A
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
Medicare Part B
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
POS
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
PPO
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
united healthcare
Workers Comp
O
352.82
33.03
529.23
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
EPO
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
HMO
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
Medicaid
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
Medicare Part A
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
Medicare Part B
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
POS
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
PPO
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86920
null
cpt
Blood unit compatibility test immediate spin technique
va
Workers Comp
O
352.82
33.03
352.82
529.23
79.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
EPO
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
HMO
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
Medicaid
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
Medicare Part A
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
Medicare Part B
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
POS
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
PPO
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86921
null
cpt
Blood unit compatibility test incubation technique
blue cross blue shield
Workers Comp
O
72.34
29.39
29.39
29.39
43.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
EPO
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
HMO
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
Medicaid
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
Medicare Part A
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
Medicare Part B
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
POS
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
PPO
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86922
null
cpt
Blood unit compatibility test antiglobulin technique
blue cross blue shield
Workers Comp
O
280.47
114.40
114.40
114.40
168.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
EPO
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
HMO
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
Medicaid
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
Medicare Part A
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
Medicare Part B
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
POS
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
PPO
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
86999
null
cpt
Transfusion medicine procedures
blue cross blue shield
Workers Comp
O
307.50
54.73
54.73
54.73
184.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
EPO
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
HMO
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
Medicaid
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
Medicare Part A
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
Medicare Part B
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
POS
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
PPO
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna
Workers Comp
I
176352.58
37217.65
51461.98
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
EPO
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
HMO
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
Medicaid
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
Medicare Part A
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
Medicare Part B
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
POS
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
PPO
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
aetna - medicare advantage
Workers Comp
I
176352.58
37217.65
43569.04
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
EPO
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
HMO
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
Medicaid
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
Medicare Part A
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
Medicare Part B
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
POS
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
PPO
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
blue cross blue shield
Workers Comp
I
176352.58
37217.65
68508.00
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
EPO
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
HMO
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
Medicaid
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
Medicare Part A
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
Medicare Part B
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
POS
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
PPO
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
humana - medicare advantage
Workers Comp
I
176352.58
37217.65
37217.65
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
EPO
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
HMO
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
Medicaid
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
Medicare Part A
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
Medicare Part B
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
POS
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
PPO
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
tricare
Workers Comp
I
176352.58
37217.65
42275.45
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
EPO
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
HMO
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
Medicaid
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
Medicare Part A
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
Medicare Part B
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
POS
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
PPO
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare
Workers Comp
I
176352.58
37217.65
127330.68
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
EPO
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
HMO
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
Medicaid
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
Medicare Part A
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
Medicare Part B
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
POS
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
PPO
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
united healthcare - medicare advantage
Workers Comp
I
176352.58
37217.65
46694.95
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
EPO
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
HMO
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
Medicaid
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
Medicare Part A
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
Medicare Part B
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
POS
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
PPO
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
870
null
ms-drg
septicemia or severe sepsis with mv >96 hours
va
Workers Comp
I
176352.58
37217.65
38768.91
127330.68
105811.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
EPO
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
HMO
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
Medicaid
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
Medicare Part A
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
Medicare Part B
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
POS
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
PPO
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield
Workers Comp
O
16.72
3.48
3.48
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
EPO
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
HMO
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
Medicaid
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
Medicare Part A
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
Medicare Part B
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
POS
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
PPO
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87015
null
cpt
Concentration of specimen for infectious agents
blue cross blue shield - medicare advantage
Workers Comp
O
16.72
3.48
7.47
7.47
10.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
EPO
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
HMO
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
Medicaid
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
Medicare Part A
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
Medicare Part B
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
POS
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
PPO
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
blue cross blue shield
Workers Comp
O
69.66
10.32
51.33
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
EPO
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
HMO
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
Medicaid
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
Medicare Part A
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
Medicare Part B
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
POS
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
PPO
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
humana - medicare advantage
Workers Comp
O
69.66
10.32
10.32
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
EPO
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
HMO
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
Medicaid
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
Medicare Part A
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
Medicare Part B
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
POS
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
PPO
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
tricare
Workers Comp
O
69.66
10.32
10.36
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
EPO
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
HMO
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
Medicaid
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
Medicare Part A
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
Medicare Part B
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
POS
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
PPO
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87040
null
cpt
Bacterial blood culture
united healthcare
Workers Comp
O
69.66
10.32
208.95
208.95
13.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
EPO
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
HMO
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
Medicaid
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
Medicare Part A
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
Medicare Part B
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
POS
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
PPO
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna
Workers Comp
O
75.56
7.57
42.46
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
EPO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
HMO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
Medicaid
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
Medicare Part A
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
Medicare Part B
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
POS
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
PPO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
aetna - medicare advantage
Workers Comp
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
EPO
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
HMO
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
Medicaid
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
Medicare Part A
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
Medicare Part B
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
POS
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
PPO
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield
Workers Comp
O
75.56
7.57
9.32
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
EPO
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
HMO
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
Medicaid
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
Medicare Part A
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
Medicare Part B
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
POS
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
PPO
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
blue cross blue shield - medicare advantage
Workers Comp
O
75.56
7.57
9.93
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
EPO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
HMO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
Medicaid
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
Medicare Part A
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
Medicare Part B
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
POS
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
PPO
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
humana - medicare advantage
Workers Comp
O
75.56
7.57
9.44
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
EPO
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
HMO
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
Medicaid
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
Medicare Part A
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
Medicare Part B
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
POS
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
PPO
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
tricare
Workers Comp
O
75.56
7.57
9.48
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
EPO
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
HMO
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
Medicaid
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
Medicare Part A
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
Medicare Part B
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
POS
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
PPO
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
united healthcare
Workers Comp
O
75.56
7.57
53.98
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
EPO
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
HMO
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
Medicaid
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
Medicare Part A
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
Medicare Part B
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
POS
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
PPO
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87045
null
cpt
Stool culture
va
Workers Comp
O
75.56
7.57
7.57
53.98
11.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
EPO
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
HMO
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
Medicaid
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
Medicare Part A
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
Medicare Part B
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
POS
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
PPO
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna
Workers Comp
O
94.54
6.11
55.78
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
EPO
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
HMO
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
Medicaid
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
Medicare Part A
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
Medicare Part B
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
POS
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
PPO
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
aetna - medicare advantage
Workers Comp
O
94.54
6.11
18.50
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
EPO
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
HMO
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
Medicaid
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
Medicare Part A
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
Medicare Part B
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
POS
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
PPO
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield
Workers Comp
O
94.54
6.11
6.11
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
EPO
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
HMO
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
Medicaid
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
Medicare Part A
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
Medicare Part B
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
POS
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
PPO
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
blue cross blue shield - medicare advantage
Workers Comp
O
94.54
6.11
6.52
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
EPO
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
HMO
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
Medicaid
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
Medicare Part A
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
Medicare Part B
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
POS
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
PPO
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
humana - medicare advantage
Workers Comp
O
94.54
6.11
9.44
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
EPO
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
HMO
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
Medicaid
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
Medicare Part A
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
Medicare Part B
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
POS
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
PPO
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
tricare
Workers Comp
O
94.54
6.11
9.48
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
EPO
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
HMO
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
Medicaid
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
Medicare Part A
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
Medicare Part B
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
POS
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
PPO
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
united healthcare
Workers Comp
O
94.54
6.11
35.46
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
EPO
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
HMO
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
Medicaid
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
Medicare Part A
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
Medicare Part B
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
POS
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
PPO
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87046
null
cpt
Stool culture additional pathogens
va
Workers Comp
O
94.54
6.11
7.57
55.78
22.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
EPO
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
HMO
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
Medicaid
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
Medicare Part A
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
Medicare Part B
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
POS
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
PPO
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna
Workers Comp
O
61.43
8.62
33.82
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
EPO
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
HMO
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
Medicaid
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
Medicare Part A
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
Medicare Part B
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
POS
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
PPO
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
aetna - medicare advantage
Workers Comp
O
61.43
8.62
8.87
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
EPO
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
HMO
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
Medicaid
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
Medicare Part A
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
Medicare Part B
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
POS
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
PPO
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield
Workers Comp
O
61.43
8.62
14.51
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
EPO
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
HMO
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
Medicaid
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
Medicare Part A
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
Medicare Part B
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
POS
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
PPO
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
blue cross blue shield - medicare advantage
Workers Comp
O
61.43
8.62
11.32
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
EPO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
HMO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
Medicaid
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
Medicare Part A
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
Medicare Part B
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
POS
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
PPO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
humana - medicare advantage
Workers Comp
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
EPO
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
HMO
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
Medicaid
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
Medicare Part A
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
Medicare Part B
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
POS
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
PPO
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
tricare
Workers Comp
O
61.43
8.62
8.66
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
EPO
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
HMO
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
Medicaid
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
Medicare Part A
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
Medicare Part B
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
POS
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
PPO
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
united healthcare
Workers Comp
O
61.43
8.62
43.88
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
EPO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
HMO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
Medicaid
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
Medicare Part A
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
Medicare Part B
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
POS
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
PPO
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
va
Workers Comp
O
61.43
8.62
8.62
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
EPO
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
HMO
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
Medicaid
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
Medicare Part A
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
Medicare Part B
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
POS
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
PPO
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87070
null
cpt
Bacterial culture any other source except urine blood or stool aerobic
webtpa
Workers Comp
O
61.43
8.62
40.96
43.88
10.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
EPO
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
HMO
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
Medicaid
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
Medicare Part A
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
Medicare Part B
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
POS
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
PPO
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna
Workers Comp
O
80.24
9.47
34.27
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
EPO
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
HMO
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
Medicaid
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
Medicare Part A
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
Medicare Part B
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
POS
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
PPO
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
aetna - medicare advantage
Workers Comp
O
80.24
9.47
9.75
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
EPO
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
HMO
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
Medicaid
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
Medicare Part A
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
Medicare Part B
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
POS
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
PPO
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield
Workers Comp
O
80.24
9.47
21.83
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
EPO
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
HMO
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
Medicaid
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
Medicare Part A
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
Medicare Part B
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
POS
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
PPO
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
blue cross blue shield - medicare advantage
Workers Comp
O
80.24
9.47
15.34
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
EPO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
HMO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
Medicaid
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
Medicare Part A
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
Medicare Part B
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
POS
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
PPO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
humana - medicare advantage
Workers Comp
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
EPO
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
HMO
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
Medicaid
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
Medicare Part A
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
Medicare Part B
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
POS
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
PPO
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
tricare
Workers Comp
O
80.24
9.47
9.51
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
EPO
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
HMO
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
Medicaid
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
Medicare Part A
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
Medicare Part B
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
POS
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
PPO
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
united healthcare
Workers Comp
O
80.24
9.47
57.31
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
EPO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
HMO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
Medicaid
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
Medicare Part A
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
Medicare Part B
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
POS
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
PPO
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87075
null
cpt
Bacterial culture any source except blood anaerobic
va
Workers Comp
O
80.24
9.47
9.47
57.31
11.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
EPO
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
HMO
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
Medicaid
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
Medicare Part A
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
Medicare Part B
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
POS
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
PPO
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
blue cross blue shield
Workers Comp
O
88.77
8.08
36.43
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
EPO
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
HMO
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
Medicaid
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
Medicare Part A
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
Medicare Part B
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
POS
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
PPO
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
tricare
Workers Comp
O
88.77
8.08
8.11
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
EPO
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
HMO
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
Medicaid
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
Medicare Part A
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
Medicare Part B
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
POS
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
PPO
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87076
null
cpt
Bacterial culture for anaerobic isolates
va
Workers Comp
O
88.77
8.08
8.08
36.43
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
EPO
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
HMO
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
Medicaid
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
Medicare Part A
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
Medicare Part B
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
POS
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
PPO
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna
Workers Comp
O
49.63
8.08
16.16
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
EPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
HMO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
Medicaid
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
Medicare Part A
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
Medicare Part B
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
POS
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
PPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
aetna - medicare advantage
Workers Comp
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
EPO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
HMO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
Medicaid
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
Medicare Part A
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
Medicare Part B
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
POS
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
PPO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield
Workers Comp
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
EPO
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
HMO
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
Medicaid
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
Medicare Part A
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
Medicare Part B
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
POS
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
PPO
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
blue cross blue shield - medicare advantage
Workers Comp
O
49.63
8.08
11.00
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
EPO
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
HMO
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
Medicaid
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
Medicare Part A
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
Medicare Part B
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
POS
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
PPO
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
cigna
Workers Comp
O
49.63
8.08
22.41
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
EPO
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
HMO
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
Medicaid
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
Medicare Part A
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
Medicare Part B
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
POS
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
PPO
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
healthchoice
Workers Comp
O
49.63
8.08
8.93
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
EPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
HMO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
Medicaid
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
Medicare Part A
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
Medicare Part B
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
POS
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
PPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
humana - medicare advantage
Workers Comp
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
EPO
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
HMO
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
Medicaid
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
Medicare Part A
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
Medicare Part B
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
POS
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
PPO
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
tricare
Workers Comp
O
49.63
8.08
8.11
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
EPO
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
HMO
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
Medicaid
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
Medicare Part A
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
Medicare Part B
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
POS
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
PPO
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare
Workers Comp
O
49.63
8.08
35.46
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
EPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
HMO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
Medicaid
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
Medicare Part A
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
Medicare Part B
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
POS
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
PPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
united healthcare - medicare advantage
Workers Comp
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
EPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
HMO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
Medicaid
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
Medicare Part A
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
Medicare Part B
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
POS
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
PPO
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
va
Workers Comp
O
49.63
8.08
8.08
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
EPO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
HMO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
Medicaid
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
Medicare Part A
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
Medicare Part B
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
POS
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
PPO
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87077
null
cpt
Bacterial culture for aerobic isolates
webtpa
Workers Comp
O
49.63
8.08
11.68
35.46
9.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
EPO
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
HMO
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
Medicaid
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
Medicare Part A
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
Medicare Part B
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
POS
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
PPO
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
aetna
Workers Comp
O
42.51
6.63
23.89
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
EPO
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
HMO
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
Medicaid
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
Medicare Part A
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
Medicare Part B
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
POS
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
PPO
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield
Workers Comp
O
42.51
6.63
19.68
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
EPO
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
HMO
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
Medicaid
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
Medicare Part A
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
Medicare Part B
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
POS
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
PPO
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
blue cross blue shield - medicare advantage
Workers Comp
O
42.51
6.63
21.84
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
EPO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
HMO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
Medicaid
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
Medicare Part A
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
Medicare Part B
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
POS
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
PPO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
geha
Workers Comp
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
EPO
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
HMO
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
Medicaid
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
Medicare Part A
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
Medicare Part B
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
POS
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
PPO
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
healthchoice
Workers Comp
O
42.51
6.63
40.49
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
EPO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
HMO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
Medicaid
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
Medicare Part A
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
Medicare Part B
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
POS
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
PPO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
humana - medicare advantage
Workers Comp
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
EPO
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
HMO
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
Medicaid
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
Medicare Part A
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
Medicare Part B
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
POS
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
PPO
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
tricare
Workers Comp
O
42.51
6.63
6.66
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
EPO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
HMO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
Medicaid
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
Medicare Part A
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
Medicare Part B
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
POS
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
PPO
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
united healthcare
Workers Comp
O
42.51
6.63
30.37
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
EPO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
HMO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
Medicaid
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
Medicare Part A
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
Medicare Part B
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
POS
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
PPO
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
va
Workers Comp
O
42.51
6.63
6.63
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
EPO
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
HMO
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
Medicaid
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
Medicare Part A
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
Medicare Part B
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
POS
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
PPO
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87081
null
cpt
Screening test for pathogenic organisms
webtpa
Workers Comp
O
42.51
6.63
28.34
40.49
7.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
EPO
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
HMO
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
Medicaid
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
Medicare Part A
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
Medicare Part B
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
POS
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
PPO
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna
Workers Comp
O
67.89
8.07
38.15
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
EPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
HMO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
Medicaid
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
Medicare Part A
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
Medicare Part B
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
POS
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
PPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
aetna - medicare advantage
Workers Comp
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
EPO
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
HMO
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
Medicaid
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
Medicare Part A
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
Medicare Part B
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
POS
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
PPO
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield
Workers Comp
O
67.89
8.07
16.36
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
EPO
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
HMO
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
Medicaid
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
Medicare Part A
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
Medicare Part B
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
POS
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
PPO
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
blue cross blue shield - medicare advantage
Workers Comp
O
67.89
8.07
15.98
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
EPO
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
HMO
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
Medicaid
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
Medicare Part A
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
Medicare Part B
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
POS
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
PPO
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
cigna
Workers Comp
O
67.89
8.07
48.04
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
EPO
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
HMO
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
Medicaid
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
Medicare Part A
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
Medicare Part B
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
POS
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
PPO
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
healthchoice
Workers Comp
O
67.89
8.07
38.99
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
EPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
HMO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
Medicaid
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
Medicare Part A
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
Medicare Part B
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
POS
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
PPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
humana - medicare advantage
Workers Comp
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
EPO
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
HMO
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
Medicaid
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
Medicare Part A
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
Medicare Part B
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
POS
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
PPO
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
medica
Workers Comp
O
67.89
8.07
25.12
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
EPO
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
HMO
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
Medicaid
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
Medicare Part A
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
Medicare Part B
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
POS
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
PPO
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
tricare
Workers Comp
O
67.89
8.07
8.10
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
EPO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
HMO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
Medicaid
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
Medicare Part A
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
Medicare Part B
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
POS
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
PPO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare
Workers Comp
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
EPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
HMO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
Medicaid
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
Medicare Part A
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
Medicare Part B
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
POS
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
PPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
united healthcare - medicare advantage
Workers Comp
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
EPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
HMO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
Medicaid
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
Medicare Part A
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
Medicare Part B
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
POS
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
PPO
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
va
Workers Comp
O
67.89
8.07
8.07
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
EPO
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
HMO
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
Medicaid
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
Medicare Part A
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
Medicare Part B
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
POS
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
PPO
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
webtpa
Workers Comp
O
67.89
8.07
45.26
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
EPO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
HMO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
Medicaid
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
Medicare Part A
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
Medicare Part B
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
POS
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
PPO
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87086
null
cpt
Bacterial colony count urine
worker comp
Workers Comp
O
67.89
8.07
48.50
48.50
9.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
EPO
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
HMO
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
Medicaid
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
Medicare Part A
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
Medicare Part B
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
POS
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
PPO
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna
Workers Comp
I
36660.55
9915.43
15230.83
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
EPO
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
HMO
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
Medicaid
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
Medicare Part A
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
Medicare Part B
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
POS
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
PPO
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
aetna - medicare advantage
Workers Comp
I
36660.55
9915.43
11699.02
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
EPO
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
HMO
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
Medicaid
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
Medicare Part A
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
Medicare Part B
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
POS
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
PPO
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield
Workers Comp
I
36660.55
9915.43
17432.39
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
EPO
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
HMO
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
Medicaid
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
POS
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
PPO
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
blue cross blue shield - medicare advantage
Workers Comp
I
36660.55
9915.43
16201.94
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
EPO
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
HMO
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
Medicaid
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
Medicare Part A
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
Medicare Part B
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
POS
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
PPO
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
humana - medicare advantage
Workers Comp
I
36660.55
9915.43
11103.63
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
EPO
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
HMO
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
Medicaid
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
Medicare Part A
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
Medicare Part B
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
POS
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
PPO
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
tricare
Workers Comp
I
36660.55
9915.43
10468.44
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
EPO
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
HMO
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
Medicaid
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
Medicare Part A
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
Medicare Part B
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
POS
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
PPO
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare
Workers Comp
I
36660.55
9915.43
22721.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
EPO
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
HMO
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
Medicaid
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
Medicare Part A
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
Medicare Part B
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
POS
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
PPO
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
united healthcare - medicare advantage
Workers Comp
I
36660.55
9915.43
9915.43
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
EPO
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
HMO
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
Medicaid
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
Medicare Part A
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
Medicare Part B
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
POS
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
PPO
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
871
null
ms-drg
septicemia or severe sepsis without mv >96 hours with mcc
va
Workers Comp
I
36660.55
9915.43
12159.73
22721.73
21996.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
EPO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
HMO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
Medicaid
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
Medicare Part A
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
Medicare Part B
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
POS
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
PPO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna
Workers Comp
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
EPO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
HMO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
Medicaid
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
Medicare Part A
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
Medicare Part B
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
POS
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
PPO
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
aetna - medicare advantage
Workers Comp
O
61.43
8.41
8.90
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
EPO
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
HMO
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
Medicaid
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
Medicare Part A
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
Medicare Part B
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
POS
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
PPO
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield
Workers Comp
O
61.43
8.41
23.69
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
EPO
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
HMO
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
Medicaid
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
Medicare Part A
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
Medicare Part B
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
POS
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
PPO
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
blue cross blue shield - medicare advantage
Workers Comp
O
61.43
8.41
22.54
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
EPO
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
HMO
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
Medicaid
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
Medicare Part A
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
Medicare Part B
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
POS
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
PPO
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
humana - medicare advantage
Workers Comp
O
61.43
8.41
8.41
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
EPO
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
HMO
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
Medicaid
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
Medicare Part A
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
Medicare Part B
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
POS
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
PPO
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
united healthcare
Workers Comp
O
61.43
8.41
43.88
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
EPO
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
HMO
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
Medicaid
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
Medicare Part A
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
Medicare Part B
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
POS
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
PPO
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87102
null
cpt
Fungal culture (mold or yeast)
webtpa
Workers Comp
O
61.43
8.41
40.96
43.88
10.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
EPO
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
HMO
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
Medicaid
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
Medicare Part A
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
Medicare Part B
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
POS
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
PPO
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87106
null
cpt
Fungal culture yeast
blue cross blue shield
Workers Comp
O
100.27
26.12
26.12
26.12
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
EPO
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
HMO
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
Medicaid
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
Medicare Part A
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
Medicare Part B
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
POS
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
PPO
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield
Workers Comp
O
104.30
10.84
14.57
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
EPO
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
HMO
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
Medicaid
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
Medicare Part A
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
Medicare Part B
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
POS
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
PPO
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
blue cross blue shield - medicare advantage
Workers Comp
O
104.30
10.84
31.38
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
EPO
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
HMO
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
Medicaid
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
Medicare Part A
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
Medicare Part B
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
POS
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
PPO
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87116
null
cpt
Culture for acid-fast bacilli
tricare
Workers Comp
O
104.30
10.84
10.84
31.38
12.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
aetna - medicare advantage
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
EPO
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
HMO
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
Medicaid
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
Medicare Part A
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
Medicare Part B
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
POS
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
PPO
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield
Workers Comp
O
24.48
5.18
7.32
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
blue cross blue shield - medicare advantage
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
EPO
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
HMO
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
Medicaid
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
Medicare Part A
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
Medicare Part B
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
POS
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
PPO
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
cigna
Workers Comp
O
24.48
5.18
16.35
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
humana - medicare advantage
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
EPO
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
HMO
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
Medicaid
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
Medicare Part A
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
Medicare Part B
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
POS
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
PPO
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
tricare
Workers Comp
O
24.48
5.18
5.20
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
EPO
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
HMO
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
Medicaid
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
Medicare Part A
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
Medicare Part B
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
POS
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
PPO
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare
Workers Comp
O
24.48
5.18
17.49
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
united healthcare - medicare advantage
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
EPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
HMO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
Medicaid
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
Medicare Part A
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
Medicare Part B
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
POS
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
PPO
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
va
Workers Comp
O
24.48
5.18
5.18
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
EPO
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
HMO
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
Medicaid
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
Medicare Part A
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
Medicare Part B
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
POS
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
PPO
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87147
null
cpt
Identification of organisms by immunologic analysis other than immunofluorescence method
webtpa
Workers Comp
O
24.48
5.18
17.14
17.49
6.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
EPO
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
HMO
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
Medicaid
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
Medicare Part A
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
Medicare Part B
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
POS
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
PPO
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna
Workers Comp
O
116.86
7.13
65.67
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
EPO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
HMO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
Medicaid
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
Medicare Part A
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
Medicare Part B
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
POS
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
PPO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
aetna - medicare advantage
Workers Comp
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
EPO
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
HMO
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
Medicaid
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
Medicare Part A
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
Medicare Part B
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
POS
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
PPO
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield
Workers Comp
O
116.86
7.13
13.92
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
EPO
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
HMO
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
Medicaid
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
Medicare Part A
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
Medicare Part B
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
POS
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
PPO
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
blue cross blue shield - medicare advantage
Workers Comp
O
116.86
7.13
13.91
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
EPO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
HMO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
Medicaid
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
Medicare Part A
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
Medicare Part B
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
POS
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
PPO
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
humana - medicare advantage
Workers Comp
O
116.86
7.13
8.90
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
EPO
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
HMO
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
Medicaid
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
Medicare Part A
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
Medicare Part B
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
POS
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
PPO
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
tricare
Workers Comp
O
116.86
7.13
8.94
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
EPO
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
HMO
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
Medicaid
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
Medicare Part A
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
Medicare Part B
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
POS
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
PPO
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
united healthcare
Workers Comp
O
116.86
7.13
83.48
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
EPO
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
HMO
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
Medicaid
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
Medicare Part A
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
Medicare Part B
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
POS
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
PPO
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87177
null
cpt
Smear for parasites
va
Workers Comp
O
116.86
7.13
7.13
83.48
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
EPO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
HMO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
Medicaid
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
Medicare Part A
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
Medicare Part B
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
POS
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
PPO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield
Workers Comp
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
EPO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
HMO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
Medicaid
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
Medicare Part A
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
Medicare Part B
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
POS
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
PPO
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
blue cross blue shield - medicare advantage
Workers Comp
O
15.58
4.75
7.21
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
EPO
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
HMO
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
Medicaid
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
Medicare Part A
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
Medicare Part B
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
POS
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
PPO
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
humana - medicare advantage
Workers Comp
O
15.58
4.75
4.75
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
EPO
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
HMO
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
Medicaid
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
Medicare Part A
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
Medicare Part B
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
POS
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
PPO
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
tricare
Workers Comp
O
15.58
4.75
4.77
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
EPO
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
HMO
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
Medicaid
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
Medicare Part A
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
Medicare Part B
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
POS
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
PPO
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87181
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) agar dilution method
united healthcare
Workers Comp
O
15.58
4.75
11.13
11.13
3.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
EPO
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
HMO
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
Medicaid
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
Medicare Part A
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
Medicare Part B
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
POS
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
PPO
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
blue cross blue shield
Workers Comp
O
18.32
2.00
2.00
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
EPO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
HMO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
Medicaid
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
Medicare Part A
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
Medicare Part B
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
POS
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
PPO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
humana - medicare advantage
Workers Comp
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
EPO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
HMO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
Medicaid
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
Medicare Part A
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
Medicare Part B
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
POS
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
PPO
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87185
null
cpt
Detection of antimicrobial drug (antibiotic antifungal antiviral)
va
Workers Comp
O
18.32
2.00
4.75
4.75
5.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
EPO
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
HMO
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
Medicaid
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
Medicare Part A
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
Medicare Part B
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
POS
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
PPO
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna
Workers Comp
O
44.84
8.07
17.30
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
EPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
HMO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
Medicaid
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
Medicare Part A
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
Medicare Part B
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
POS
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
PPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
aetna - medicare advantage
Workers Comp
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
EPO
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
HMO
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
Medicaid
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
Medicare Part A
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
Medicare Part B
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
POS
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
PPO
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield
Workers Comp
O
44.84
8.07
10.31
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
EPO
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
HMO
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
Medicaid
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
Medicare Part A
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
Medicare Part B
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
POS
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
PPO
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
blue cross blue shield - medicare advantage
Workers Comp
O
44.84
8.07
9.96
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
EPO
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
HMO
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
Medicaid
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
Medicare Part A
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
Medicare Part B
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
POS
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
PPO
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
cigna
Workers Comp
O
44.84
8.07
20.25
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
EPO
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
HMO
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
Medicaid
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
Medicare Part A
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
Medicare Part B
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
POS
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
PPO
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
healthchoice
Workers Comp
O
44.84
8.07
8.07
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
EPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
HMO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
Medicaid
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
Medicare Part A
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
Medicare Part B
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
POS
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
PPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
humana - medicare advantage
Workers Comp
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
EPO
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
HMO
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
Medicaid
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
Medicare Part A
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
Medicare Part B
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
POS
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
PPO
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
tricare
Workers Comp
O
44.84
8.07
8.69
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
EPO
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
HMO
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
Medicaid
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
Medicare Part A
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
Medicare Part B
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
POS
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
PPO
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare
Workers Comp
O
44.84
8.07
32.03
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
EPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
HMO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
Medicaid
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
Medicare Part A
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
Medicare Part B
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
POS
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
PPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
united healthcare - medicare advantage
Workers Comp
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
EPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
HMO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
Medicaid
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
Medicare Part A
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
Medicare Part B
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
POS
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
PPO
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
va
Workers Comp
O
44.84
8.07
8.65
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
EPO
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
HMO
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
Medicaid
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
Medicare Part A
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
Medicare Part B
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
POS
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
PPO
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87186
null
cpt
Evaluation of antimicrobial drug (antibiotic antifungal antiviral) microdilution or agar dilution
webtpa
Workers Comp
O
44.84
8.07
10.56
32.03
10.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
EPO
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
HMO
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
Medicaid
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
Medicare Part A
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
Medicare Part B
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
POS
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
PPO
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna
Workers Comp
I
21637.05
4982.41
5780.37
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
EPO
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
HMO
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
Medicaid
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
Medicare Part A
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
Medicare Part B
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
POS
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
PPO
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
aetna - medicare advantage
Workers Comp
I
21637.05
4982.41
6904.38
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
EPO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
HMO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
Medicaid
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
Medicare Part A
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
Medicare Part B
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
POS
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
PPO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield
Workers Comp
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
EPO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
HMO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
Medicaid
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
POS
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
PPO
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
21637.05
4982.41
8660.91
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
EPO
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
HMO
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
Medicaid
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
Medicare Part A
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
Medicare Part B
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
POS
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
PPO
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
humana - medicare advantage
Workers Comp
I
21637.05
4982.41
6316.83
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
EPO
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
HMO
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
Medicaid
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
Medicare Part A
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
Medicare Part B
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
POS
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
PPO
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
tricare
Workers Comp
I
21637.05
4982.41
4982.41
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
EPO
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
HMO
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
Medicaid
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
Medicare Part A
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
Medicare Part B
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
POS
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
PPO
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
united healthcare
Workers Comp
I
21637.05
4982.41
15942.66
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
EPO
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
HMO
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
Medicaid
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
Medicare Part A
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
Medicare Part B
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
POS
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
PPO
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
va
Workers Comp
I
21637.05
4982.41
8904.04
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
EPO
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
HMO
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
Medicaid
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
Medicare Part A
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
Medicare Part B
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
POS
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
PPO
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
872
null
ms-drg
septicemia or severe sepsis without mv >96 hours without mcc
webtpa
Workers Comp
I
21637.05
4982.41
16772.16
16772.16
12982.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
EPO
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
HMO
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
Medicaid
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
Medicare Part A
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
Medicare Part B
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
POS
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
PPO
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna
Workers Comp
O
82.58
4.27
41.59
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
EPO
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
HMO
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
Medicaid
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
Medicare Part A
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
Medicare Part B
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
POS
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
PPO
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
aetna - medicare advantage
Workers Comp
O
82.58
4.27
4.40
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
EPO
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
HMO
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
Medicaid
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
Medicare Part A
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
Medicare Part B
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
POS
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
PPO
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield
Workers Comp
O
82.58
4.27
19.08
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
EPO
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
HMO
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
Medicaid
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
Medicare Part A
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
Medicare Part B
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
POS
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
PPO
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
blue cross blue shield - medicare advantage
Workers Comp
O
82.58
4.27
15.21
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
EPO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
HMO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
Medicaid
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
Medicare Part A
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
Medicare Part B
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
POS
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
PPO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
humana - medicare advantage
Workers Comp
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
EPO
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
HMO
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
Medicaid
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
Medicare Part A
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
Medicare Part B
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
POS
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
PPO
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
tricare
Workers Comp
O
82.58
4.27
4.29
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
EPO
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
HMO
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
Medicaid
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
Medicare Part A
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
Medicare Part B
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
POS
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
PPO
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
united healthcare
Workers Comp
O
82.58
4.27
58.99
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
EPO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
HMO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
Medicaid
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
Medicare Part A
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
Medicare Part B
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
POS
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
PPO
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87205
null
cpt
Special Gram or Giemsa stain for microorganism
va
Workers Comp
O
82.58
4.27
4.27
58.99
5.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
EPO
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
HMO
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
Medicaid
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
Medicare Part A
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
Medicare Part B
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
POS
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
PPO
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield
Workers Comp
O
13.48
2.80
2.80
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
EPO
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
HMO
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
Medicaid
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
Medicare Part A
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
Medicare Part B
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
POS
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
PPO
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87206
null
cpt
Special fluorescent and/or acid fast stain for microorganism
blue cross blue shield - medicare advantage
Workers Comp
O
13.48
2.80
6.03
6.03
8.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
EPO
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
HMO
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
Medicaid
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
Medicare Part A
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
Medicare Part B
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
POS
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
PPO
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87207
null
cpt
Special stain for inclusion bodies or parasites
tricare
Workers Comp
O
14.98
6.01
6.01
6.01
8.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
EPO
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
HMO
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
Medicaid
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
Medicare Part A
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
Medicare Part B
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
POS
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
PPO
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield
Workers Comp
O
95.71
14.76
14.76
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
EPO
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
HMO
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
Medicaid
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
Medicare Part A
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
Medicare Part B
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
POS
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
PPO
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
blue cross blue shield - medicare advantage
Workers Comp
O
95.71
14.76
80.39
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
EPO
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
HMO
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
Medicaid
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
Medicare Part A
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
Medicare Part B
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
POS
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
PPO
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
cigna
Workers Comp
O
95.71
14.76
67.73
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
EPO
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
HMO
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
Medicaid
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
Medicare Part A
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
Medicare Part B
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
POS
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
PPO
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87210
null
cpt
Smear for infectious agents
united healthcare
Workers Comp
O
95.71
14.76
68.37
80.39
20.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
EPO
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
HMO
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
Medicaid
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
Medicare Part A
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
Medicare Part B
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
POS
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
PPO
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87252
null
cpt
Tissue culture inoculation for virus isolation
aetna
Workers Comp
O
139.12
80.69
80.69
80.69
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
EPO
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
HMO
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
Medicaid
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
Medicare Part A
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
Medicare Part B
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
POS
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
PPO
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
aetna
Workers Comp
O
116.86
33.86
66.73
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
EPO
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
HMO
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
Medicaid
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
Medicare Part A
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
Medicare Part B
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
POS
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
PPO
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield
Workers Comp
O
116.86
33.86
39.59
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
EPO
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
HMO
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
Medicaid
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
Medicare Part A
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
Medicare Part B
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
POS
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
PPO
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
blue cross blue shield - medicare advantage
Workers Comp
O
116.86
33.86
68.96
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
EPO
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
HMO
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
Medicaid
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
Medicare Part A
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
Medicare Part B
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
POS
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
PPO
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
humana - medicare advantage
Workers Comp
O
116.86
33.86
33.86
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
EPO
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
HMO
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
Medicaid
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
Medicare Part A
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
Medicare Part B
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
POS
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
PPO
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
tricare
Workers Comp
O
116.86
33.86
34.00
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
EPO
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
HMO
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
Medicaid
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
Medicare Part A
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
Medicare Part B
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
POS
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
PPO
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87255
null
cpt
Virus isolation
webtpa
Workers Comp
O
116.86
33.86
77.91
77.91
39.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
EPO
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
HMO
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
Medicaid
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
Medicare Part A
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
Medicare Part B
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
POS
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
PPO
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna
Workers Comp
O
56.64
6.98
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
EPO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
HMO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
Medicaid
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
Medicare Part A
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
Medicare Part B
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
POS
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
PPO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
aetna - medicare advantage
Workers Comp
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
EPO
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
HMO
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
Medicaid
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
Medicare Part A
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
Medicare Part B
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
POS
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
PPO
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield
Workers Comp
O
56.64
6.98
6.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
EPO
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
HMO
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
Medicaid
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
Medicare Part A
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
Medicare Part B
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
POS
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
PPO
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
blue cross blue shield - medicare advantage
Workers Comp
O
56.64
6.98
7.44
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
EPO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
HMO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
Medicaid
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
Medicare Part A
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
Medicare Part B
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
POS
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
PPO
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
humana - medicare advantage
Workers Comp
O
56.64
6.98
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
EPO
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
HMO
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
Medicaid
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
Medicare Part A
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
Medicare Part B
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
POS
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
PPO
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
tricare
Workers Comp
O
56.64
6.98
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
EPO
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
HMO
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
Medicaid
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
Medicare Part A
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
Medicare Part B
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
POS
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
PPO
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
united healthcare
Workers Comp
O
56.64
6.98
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
EPO
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
HMO
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
Medicaid
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
Medicare Part A
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
Medicare Part B
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
POS
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
PPO
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87301
null
cpt
Detection test by immunoassay technique for adenovirus enteric types 40/41
va
Workers Comp
O
56.64
6.98
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
EPO
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
HMO
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
Medicaid
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
Medicare Part A
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
Medicare Part B
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
POS
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
PPO
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87324
null
cpt
Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen)
blue cross blue shield
Workers Comp
O
29.95
18.34
18.34
18.34
17.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
EPO
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
HMO
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
Medicaid
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
Medicare Part A
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
Medicare Part B
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
POS
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
PPO
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
aetna
Workers Comp
O
344.57
9.15
203.30
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
EPO
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
HMO
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
Medicaid
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
Medicare Part A
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
Medicare Part B
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
POS
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
PPO
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield
Workers Comp
O
344.57
9.15
24.45
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
EPO
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
HMO
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
Medicaid
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
Medicare Part A
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
Medicare Part B
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
POS
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
PPO
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
blue cross blue shield - medicare advantage
Workers Comp
O
344.57
9.15
27.07
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
EPO
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
HMO
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
Medicaid
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
Medicare Part A
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
Medicare Part B
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
POS
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
PPO
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
cigna
Workers Comp
O
344.57
9.15
230.05
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
EPO
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
HMO
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
Medicaid
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
Medicare Part A
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
Medicare Part B
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
POS
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
PPO
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
humana - medicare advantage
Workers Comp
O
344.57
9.15
14.38
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
EPO
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
HMO
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
Medicaid
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
Medicare Part A
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
Medicare Part B
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
POS
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
PPO
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
tricare
Workers Comp
O
344.57
9.15
14.44
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
EPO
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
HMO
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
Medicaid
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
Medicare Part A
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
Medicare Part B
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
POS
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
PPO
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
united healthcare
Workers Comp
O
344.57
9.15
246.13
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
EPO
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
HMO
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
Medicaid
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
Medicare Part A
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
Medicare Part B
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
POS
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
PPO
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
va
Workers Comp
O
344.57
9.15
9.15
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
EPO
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
HMO
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
Medicaid
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
Medicare Part A
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
Medicare Part B
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
POS
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
PPO
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87338
null
cpt
Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool multiple-step method
webtpa
Workers Comp
O
344.57
9.15
241.20
246.13
17.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
EPO
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
HMO
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
Medicaid
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
Medicare Part A
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
Medicare Part B
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
POS
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
PPO
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
aetna
Workers Comp
O
75.56
9.59
44.74
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
EPO
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
HMO
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
Medicaid
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
Medicare Part A
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
Medicare Part B
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
POS
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
PPO
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield
Workers Comp
O
75.56
9.59
10.44
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
EPO
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
HMO
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
Medicaid
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
Medicare Part A
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
Medicare Part B
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
POS
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
PPO
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
blue cross blue shield - medicare advantage
Workers Comp
O
75.56
9.59
9.59
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
EPO
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
HMO
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
Medicaid
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
Medicare Part A
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
Medicare Part B
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
POS
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
PPO
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
cigna
Workers Comp
O
75.56
9.59
53.47
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
EPO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
HMO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
Medicaid
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
Medicare Part A
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
Medicare Part B
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
POS
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
PPO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
humana - medicare advantage
Workers Comp
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
EPO
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
HMO
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
Medicaid
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
Medicare Part A
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
Medicare Part B
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
POS
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
PPO
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
tricare
Workers Comp
O
75.56
9.59
11.53
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
EPO
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
HMO
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
Medicaid
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
Medicare Part A
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
Medicare Part B
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
POS
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
PPO
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
united healthcare
Workers Comp
O
75.56
9.59
53.98
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
EPO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
HMO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
Medicaid
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
Medicare Part A
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
Medicare Part B
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
POS
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
PPO
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87340
null
cpt
Detection test by immunoassay technique for Hepatitis B surface antigen
va
Workers Comp
O
75.56
9.59
10.33
53.98
12.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
EPO
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
HMO
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
Medicaid
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
Medicare Part A
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
Medicare Part B
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
POS
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
PPO
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
blue cross blue shield - medicare advantage
Workers Comp
O
28.83
5.95
5.95
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
EPO
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
HMO
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
Medicaid
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
Medicare Part A
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
Medicare Part B
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
POS
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
PPO
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87350
null
cpt
Detection test by immunoassay technique for Hepatitis Be surface antigen
humana - medicare advantage
Workers Comp
O
28.83
5.95
11.53
11.53
17.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
EPO
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
HMO
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
Medicaid
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
Medicare Part A
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
Medicare Part B
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
POS
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
PPO
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87385
null
cpt
Detection test by immunoassay technique for histoplasma capsulatum (parasite)
blue cross blue shield
Workers Comp
O
62.32
13.72
13.72
13.72
37.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
EPO
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
HMO
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
Medicaid
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
Medicare Part A
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
Medicare Part B
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
POS
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
PPO
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna
Workers Comp
O
95.60
12.30
54.59
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
EPO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
HMO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
Medicaid
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
Medicare Part A
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
Medicare Part B
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
POS
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
PPO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
aetna - medicare advantage
Workers Comp
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
EPO
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
HMO
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
Medicaid
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
Medicare Part A
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
Medicare Part B
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
POS
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
PPO
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield
Workers Comp
O
95.60
12.30
15.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
EPO
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
HMO
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
Medicaid
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
Medicare Part A
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
Medicare Part B
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
POS
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
PPO
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
blue cross blue shield - medicare advantage
Workers Comp
O
95.60
12.30
12.30
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
EPO
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
HMO
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
Medicaid
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
Medicare Part A
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
Medicare Part B
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
POS
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
PPO
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
cigna
Workers Comp
O
95.60
12.30
67.65
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
EPO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
HMO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
Medicaid
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
Medicare Part A
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
Medicare Part B
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
POS
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
PPO
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
humana - medicare advantage
Workers Comp
O
95.60
12.30
24.08
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
EPO
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
HMO
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
Medicaid
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
Medicare Part A
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
Medicare Part B
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
POS
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
PPO
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
medica
Workers Comp
O
95.60
12.30
35.37
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
EPO
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
HMO
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
Medicaid
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
Medicare Part A
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
Medicare Part B
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
POS
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
PPO
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
tricare
Workers Comp
O
95.60
12.30
24.18
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
EPO
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
HMO
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
Medicaid
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
Medicare Part A
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
Medicare Part B
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
POS
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
PPO
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
united healthcare
Workers Comp
O
95.60
12.30
68.29
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
EPO
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
HMO
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
Medicaid
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
Medicare Part A
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
Medicare Part B
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
POS
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
PPO
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
va
Workers Comp
O
95.60
12.30
14.51
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
EPO
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
HMO
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
Medicaid
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
Medicare Part A
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
Medicare Part B
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
POS
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
PPO
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87389
null
cpt
Detection test by immunoassay technique for HIV-1 and HIV-2
webtpa
Workers Comp
O
95.60
12.30
63.74
68.29
28.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
EPO
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
HMO
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
Medicaid
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
Medicare Part A
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
Medicare Part B
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
POS
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
PPO
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna
Workers Comp
O
56.64
6.91
31.83
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
EPO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
HMO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
Medicaid
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
Medicare Part A
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
Medicare Part B
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
POS
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
PPO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
aetna - medicare advantage
Workers Comp
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
EPO
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
HMO
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
Medicaid
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
Medicare Part A
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
Medicare Part B
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
POS
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
PPO
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield
Workers Comp
O
56.64
6.91
6.91
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
EPO
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
HMO
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
Medicaid
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
Medicare Part A
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
Medicare Part B
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
POS
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
PPO
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
blue cross blue shield - medicare advantage
Workers Comp
O
56.64
6.91
7.75
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
EPO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
HMO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
Medicaid
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
Medicare Part A
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
Medicare Part B
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
POS
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
PPO
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
humana - medicare advantage
Workers Comp
O
56.64
6.91
11.98
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
EPO
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
HMO
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
Medicaid
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
Medicare Part A
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
Medicare Part B
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
POS
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
PPO
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
tricare
Workers Comp
O
56.64
6.91
12.03
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
EPO
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
HMO
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
Medicaid
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
Medicare Part A
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
Medicare Part B
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
POS
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
PPO
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
united healthcare
Workers Comp
O
56.64
6.91
40.46
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
EPO
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
HMO
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
Medicaid
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
Medicare Part A
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
Medicare Part B
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
POS
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
PPO
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87427
null
cpt
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)
va
Workers Comp
O
56.64
6.91
9.60
40.46
14.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
EPO
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
HMO
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
Medicaid
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
Medicare Part A
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
Medicare Part B
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
POS
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
PPO
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87449
null
cpt
Immunologic analysis for detection of organism by immunoassay technique multiple-step method
blue cross blue shield
Workers Comp
O
108.07
18.33
18.33
18.33
64.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
EPO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
HMO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
Medicaid
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
Medicare Part A
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
Medicare Part B
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
POS
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
PPO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
aetna
Workers Comp
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
EPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
HMO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
Medicaid
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
Medicare Part A
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
Medicare Part B
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
POS
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
PPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield
Workers Comp
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
EPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
HMO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
Medicaid
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
POS
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
PPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
EPO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
HMO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
Medicaid
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
Medicare Part A
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
Medicare Part B
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
POS
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
PPO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
cigna
Workers Comp
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
EPO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
HMO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
Medicaid
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
Medicare Part A
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
Medicare Part B
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
POS
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
PPO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
healthchoice
Workers Comp
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
EPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
HMO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
Medicaid
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
Medicare Part A
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
Medicare Part B
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
POS
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
PPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana
Workers Comp
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
EPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
HMO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
Medicaid
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
Medicare Part A
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
Medicare Part B
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
POS
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
PPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
humana - medicare advantage
Workers Comp
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
EPO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
HMO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
Medicaid
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
Medicare Part A
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
Medicare Part B
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
POS
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
PPO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
medica
Workers Comp
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
EPO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
HMO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
Medicaid
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
Medicare Part A
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
Medicare Part B
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
POS
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
PPO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
tricare
Workers Comp
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
EPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
HMO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
Medicaid
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
Medicare Part A
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
Medicare Part B
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
POS
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
PPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare
Workers Comp
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
EPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
HMO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
Medicaid
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
Medicare Part A
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
Medicare Part B
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
POS
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
PPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
united healthcare - medicare advantage
Workers Comp
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
EPO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
HMO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
Medicaid
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
Medicare Part A
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
Medicare Part B
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
POS
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
PPO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
va
Workers Comp
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
EPO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
HMO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
Medicaid
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
Medicare Part A
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
Medicare Part B
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
POS
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
PPO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87480
null
cpt
Detection test for candida species (yeast) direct probe technique
webtpa
Workers Comp
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
EPO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
HMO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
Medicaid
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
Medicare Part A
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
Medicare Part B
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
POS
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
PPO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
aetna
Workers Comp
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
EPO
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
HMO
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
Medicaid
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
Medicare Part A
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
Medicare Part B
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
POS
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
PPO
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield
Workers Comp
O
139.23
21.05
37.29
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
POS
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
EPO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
HMO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
Medicaid
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
Medicare Part A
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
Medicare Part B
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
POS
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
PPO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
cigna
Workers Comp
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
EPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
HMO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
Medicaid
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
Medicare Part A
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
Medicare Part B
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
POS
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
PPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana
Workers Comp
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
EPO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
HMO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
Medicaid
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
Medicare Part A
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
Medicare Part B
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
POS
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
PPO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
humana - medicare advantage
Workers Comp
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
EPO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
HMO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
Medicaid
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
Medicare Part A
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
Medicare Part B
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
POS
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
PPO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
medica
Workers Comp
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
EPO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
HMO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
Medicaid
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
Medicare Part A
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
Medicare Part B
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
POS
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
PPO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
tricare
Workers Comp
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
EPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
HMO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
Medicaid
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
Medicare Part A
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
Medicare Part B
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
POS
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
PPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
united healthcare
Workers Comp
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
EPO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
HMO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
Medicaid
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
Medicare Part A
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
Medicare Part B
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
POS
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
PPO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
va
Workers Comp
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
EPO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
HMO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
Medicaid
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
Medicare Part A
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
Medicare Part B
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
POS
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
PPO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87491
null
cpt
Detection test by nucleic acid for chlamydia trachomatis amplified probe technique
webtpa
Workers Comp
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
EPO
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
HMO
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
Medicaid
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
Medicare Part A
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
Medicare Part B
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
POS
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
PPO
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
aetna - medicare advantage
Workers Comp
O
94.37
12.75
55.91
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
EPO
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
HMO
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
Medicaid
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
Medicare Part A
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
Medicare Part B
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
POS
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
PPO
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield
Workers Comp
O
94.37
12.75
12.75
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
POS
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
94.37
12.75
12.92
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
EPO
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
HMO
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
Medicaid
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
Medicare Part A
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
Medicare Part B
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
POS
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
PPO
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
humana - medicare advantage
Workers Comp
O
94.37
12.75
37.27
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
EPO
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
HMO
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
Medicaid
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
Medicare Part A
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
Medicare Part B
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
POS
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
PPO
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
tricare
Workers Comp
O
94.37
12.75
37.42
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
EPO
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
HMO
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
Medicaid
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
Medicare Part A
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
Medicare Part B
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
POS
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
PPO
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
united healthcare
Workers Comp
O
94.37
12.75
67.41
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
EPO
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
HMO
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
Medicaid
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
Medicare Part A
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
Medicare Part B
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
POS
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
PPO
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
va
Workers Comp
O
94.37
12.75
29.86
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
EPO
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
HMO
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
Medicaid
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
Medicare Part A
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
Medicare Part B
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
POS
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
PPO
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87493
null
cpt
Detection test by nucleic acid for clostridium difficile amplified probe technique
webtpa
Workers Comp
O
94.37
12.75
66.06
67.41
88.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
EPO
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
HMO
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
Medicaid
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
Medicare Part A
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
Medicare Part B
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
POS
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
PPO
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87496
null
cpt
Detection test by nucleic acid for Cytomegalovirus (CMV) amplified probe technique
aetna
Workers Comp
O
171.72
108.93
108.93
108.93
103.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
EPO
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
HMO
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
Medicaid
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
Medicare Part A
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
Medicare Part B
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
POS
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
PPO
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
blue cross blue shield
Workers Comp
O
219.26
23.33
23.33
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
EPO
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
HMO
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
Medicaid
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
Medicare Part A
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
Medicare Part B
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
POS
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
PPO
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
humana - medicare advantage
Workers Comp
O
219.26
23.33
42.84
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
EPO
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
HMO
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
Medicaid
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
Medicare Part A
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
Medicare Part B
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
POS
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
PPO
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87497
null
cpt
Detection test by nucleic acid for cytomegalovirus quantification
tricare
Workers Comp
O
219.26
23.33
43.02
43.02
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
EPO
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
HMO
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
Medicaid
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
Medicare Part A
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
Medicare Part B
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
POS
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
PPO
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield
Workers Comp
O
197.16
15.47
54.99
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
EPO
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
HMO
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
Medicaid
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
Medicare Part A
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
Medicare Part B
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
POS
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
PPO
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
blue cross blue shield - medicare advantage
Workers Comp
O
197.16
15.47
15.47
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
EPO
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
HMO
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
Medicaid
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
Medicare Part A
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
Medicare Part B
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
POS
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
PPO
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
tricare
Workers Comp
O
197.16
15.47
96.19
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
EPO
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
HMO
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
Medicaid
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
Medicare Part A
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
Medicare Part B
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
POS
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
PPO
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87502
null
cpt
Detection test by nucleic acid for multiple types influenza virus
webtpa
Workers Comp
O
197.16
15.47
138.01
138.01
112.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
EPO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
HMO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
Medicaid
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
Medicare Part A
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
Medicare Part B
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
POS
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
PPO
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
aetna
Workers Comp
O
101.50
12.03
58.87
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
EPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
HMO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
Medicaid
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
Medicare Part A
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
Medicare Part B
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
POS
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
PPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield
Workers Comp
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
EPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
HMO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
Medicaid
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
POS
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
PPO
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
101.50
12.03
28.21
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
EPO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
HMO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
Medicaid
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
Medicare Part A
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
Medicare Part B
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
POS
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
PPO
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
cigna
Workers Comp
O
101.50
12.03
69.80
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
EPO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
HMO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
Medicaid
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
Medicare Part A
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
Medicare Part B
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
POS
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
PPO
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
healthchoice
Workers Comp
O
101.50
12.03
40.84
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
EPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
HMO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
Medicaid
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
Medicare Part A
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
Medicare Part B
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
POS
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
PPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana
Workers Comp
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
EPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
HMO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
Medicaid
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
Medicare Part A
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
Medicare Part B
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
POS
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
PPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
humana - medicare advantage
Workers Comp
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
EPO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
HMO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
Medicaid
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
Medicare Part A
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
Medicare Part B
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
POS
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
PPO
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
medica
Workers Comp
O
101.50
12.03
12.03
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
EPO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
HMO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
Medicaid
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
Medicare Part A
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
Medicare Part B
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
POS
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
PPO
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
tricare
Workers Comp
O
101.50
12.03
20.13
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
EPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
HMO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
Medicaid
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
Medicare Part A
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
Medicare Part B
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
POS
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
PPO
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare
Workers Comp
O
101.50
12.03
72.50
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
EPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
HMO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
Medicaid
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
Medicare Part A
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
Medicare Part B
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
POS
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
PPO
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
united healthcare - medicare advantage
Workers Comp
O
101.50
12.03
20.05
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
EPO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
HMO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
Medicaid
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
Medicare Part A
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
Medicare Part B
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
POS
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
PPO
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
va
Workers Comp
O
101.50
12.03
13.42
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
EPO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
HMO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
Medicaid
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
Medicare Part A
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
Medicare Part B
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
POS
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
PPO
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87510
null
cpt
Detection test for gardnerella vaginalis (bacteria) direct probe technique
webtpa
Workers Comp
O
101.50
12.03
67.67
72.50
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
EPO
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
HMO
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
Medicaid
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
Medicare Part A
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
Medicare Part B
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
POS
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
PPO
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield
Workers Comp
O
193.66
42.84
63.65
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
EPO
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
HMO
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
Medicaid
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
Medicare Part A
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
Medicare Part B
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
POS
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
PPO
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
blue cross blue shield - medicare advantage
Workers Comp
O
193.66
42.84
49.17
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
EPO
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
HMO
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
Medicaid
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
Medicare Part A
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
Medicare Part B
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
POS
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
PPO
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
humana - medicare advantage
Workers Comp
O
193.66
42.84
42.84
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
EPO
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
HMO
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
Medicaid
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
Medicare Part A
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
Medicare Part B
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
POS
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
PPO
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87517
null
cpt
Detection test by nucleic acid for Hepatitis B virus quantification
tricare
Workers Comp
O
193.66
42.84
43.02
63.65
116.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
EPO
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
HMO
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
Medicaid
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
Medicare Part A
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
Medicare Part B
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
POS
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
PPO
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield
Workers Comp
O
466.34
35.76
48.28
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
EPO
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
HMO
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
Medicaid
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
Medicare Part A
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
Medicare Part B
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
POS
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
PPO
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
blue cross blue shield - medicare advantage
Workers Comp
O
466.34
35.76
64.17
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
EPO
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
HMO
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
Medicaid
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
Medicare Part A
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
Medicare Part B
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
POS
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
PPO
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
cigna
Workers Comp
O
466.34
35.76
330.00
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
EPO
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
HMO
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
Medicaid
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
Medicare Part A
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
Medicare Part B
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
POS
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
PPO
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
humana - medicare advantage
Workers Comp
O
466.34
35.76
42.84
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
EPO
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
HMO
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
Medicaid
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
Medicare Part A
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
Medicare Part B
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
POS
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
PPO
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
tricare
Workers Comp
O
466.34
35.76
43.02
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
EPO
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
HMO
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
Medicaid
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
Medicare Part A
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
Medicare Part B
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
POS
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
PPO
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
va
Workers Comp
O
466.34
35.76
35.76
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
EPO
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
HMO
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
Medicaid
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
Medicare Part A
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
Medicare Part B
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
POS
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
PPO
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87522
null
cpt
Detection test by nucleic acid for Hepatitis C virus quantification
webtpa
Workers Comp
O
466.34
35.76
326.44
330.00
51.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
EPO
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
HMO
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
Medicaid
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
Medicare Part A
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
Medicare Part B
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
POS
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
PPO
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
aetna
Workers Comp
O
376.19
61.47
221.95
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
EPO
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
HMO
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
Medicaid
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
Medicare Part A
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
Medicare Part B
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
POS
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
PPO
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87535
null
cpt
Detection test by nucleic acid for HIV-1 virus amplified probe technique
blue cross blue shield
Workers Comp
O
376.19
61.47
61.47
221.95
225.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
EPO
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
HMO
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
Medicaid
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
Medicare Part A
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
Medicare Part B
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
POS
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
PPO
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
aetna
Workers Comp
O
489.72
68.70
289.97
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
EPO
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
HMO
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
Medicaid
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
Medicare Part A
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
Medicare Part B
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
POS
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
PPO
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield
Workers Comp
O
489.72
68.70
68.70
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
EPO
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
HMO
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
Medicaid
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
Medicare Part A
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
Medicare Part B
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
POS
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
PPO
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
blue cross blue shield - medicare advantage
Workers Comp
O
489.72
68.70
79.34
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
EPO
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
HMO
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
Medicaid
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
Medicare Part A
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
Medicare Part B
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
POS
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
PPO
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
humana - medicare advantage
Workers Comp
O
489.72
68.70
85.10
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
EPO
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
HMO
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
Medicaid
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
Medicare Part A
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
Medicare Part B
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
POS
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
PPO
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87536
null
cpt
Detection test by nucleic acid for HIV-1 virus quantification
tricare
Workers Comp
O
489.72
68.70
90.20
289.97
293.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
EPO
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
HMO
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
Medicaid
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
Medicare Part A
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
Medicare Part B
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
POS
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
PPO
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield
Workers Comp
O
104.20
21.65
21.65
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87556
null
cpt
Detection test by nucleic acid for Mycobacteria tuberculosis (TB bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
104.20
21.65
46.64
46.64
62.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
EPO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
HMO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
Medicaid
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
Medicare Part A
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
Medicare Part B
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
POS
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
PPO
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
aetna
Workers Comp
O
139.23
21.05
80.75
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
EPO
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
HMO
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
Medicaid
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
Medicare Part A
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
Medicare Part B
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
POS
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
PPO
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield
Workers Comp
O
139.23
21.05
37.28
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
139.23
21.05
38.69
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
EPO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
HMO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
Medicaid
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
Medicare Part A
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
Medicare Part B
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
POS
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
PPO
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
cigna
Workers Comp
O
139.23
21.05
98.52
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
EPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
HMO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
Medicaid
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
Medicare Part A
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
Medicare Part B
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
POS
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
PPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana
Workers Comp
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
EPO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
HMO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
Medicaid
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
Medicare Part A
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
Medicare Part B
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
POS
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
PPO
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
humana - medicare advantage
Workers Comp
O
139.23
21.05
35.09
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
EPO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
HMO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
Medicaid
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
Medicare Part A
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
Medicare Part B
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
POS
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
PPO
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
medica
Workers Comp
O
139.23
21.05
21.05
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
EPO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
HMO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
Medicaid
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
Medicare Part A
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
Medicare Part B
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
POS
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
PPO
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
tricare
Workers Comp
O
139.23
21.05
35.23
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
EPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
HMO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
Medicaid
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
Medicare Part A
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
Medicare Part B
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
POS
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
PPO
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
united healthcare
Workers Comp
O
139.23
21.05
99.45
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
EPO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
HMO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
Medicaid
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
Medicare Part A
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
Medicare Part B
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
POS
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
PPO
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
va
Workers Comp
O
139.23
21.05
23.49
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
EPO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
HMO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
Medicaid
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
Medicare Part A
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
Medicare Part B
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
POS
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
PPO
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87591
null
cpt
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria) amplified probe technique
webtpa
Workers Comp
O
139.23
21.05
92.82
99.45
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
EPO
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
HMO
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
Medicaid
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
Medicare Part A
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
Medicare Part B
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
POS
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
PPO
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
aetna
Workers Comp
O
102.35
21.14
58.44
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
EPO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
HMO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
Medicaid
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
Medicare Part A
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
Medicare Part B
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
POS
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
PPO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield
Workers Comp
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
EPO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
HMO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
Medicaid
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
Medicare Part A
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
Medicare Part B
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
POS
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
PPO
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
blue cross blue shield - medicare advantage
Workers Comp
O
102.35
21.14
28.45
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
EPO
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
HMO
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
Medicaid
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
Medicare Part A
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
Medicare Part B
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
POS
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
PPO
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
cigna
Workers Comp
O
102.35
21.14
72.43
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
EPO
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
HMO
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
Medicaid
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
Medicare Part A
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
Medicare Part B
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
POS
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
PPO
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana
Workers Comp
O
102.35
21.14
73.11
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
EPO
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
HMO
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
Medicaid
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
Medicare Part A
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
Medicare Part B
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
POS
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
PPO
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
humana - medicare advantage
Workers Comp
O
102.35
21.14
35.09
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
EPO
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
HMO
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
Medicaid
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
Medicare Part A
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
Medicare Part B
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
POS
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
PPO
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
tricare
Workers Comp
O
102.35
21.14
35.23
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
EPO
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
HMO
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
Medicaid
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
Medicare Part A
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
Medicare Part B
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
POS
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
PPO
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
va
Workers Comp
O
102.35
21.14
21.14
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
EPO
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
HMO
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
Medicaid
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
Medicare Part A
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
Medicare Part B
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
POS
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
PPO
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87624
null
cpt
Detection test by nucleic acid for human papillomavirus (hpv) high-risk types
webtpa
Workers Comp
O
102.35
21.14
68.24
73.11
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
EPO
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
HMO
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
Medicaid
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
Medicare Part A
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
Medicare Part B
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
POS
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
PPO
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87631
null
cpt
Detection test by nucleic acid for multiple types of respiratory virus multiple types or subtypes 3-5 targets
blue cross blue shield
Workers Comp
O
299.87
79.34
79.34
79.34
64.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
EPO
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
HMO
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
Medicaid
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
Medicare Part A
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
Medicare Part B
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
POS
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
PPO
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna
Workers Comp
O
168.00
51.31
97.44
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
EPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
HMO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
Medicaid
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
Medicare Part A
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
Medicare Part B
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
POS
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
PPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
aetna - medicare advantage
Workers Comp
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
EPO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
HMO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
Medicaid
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
Medicare Part A
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
Medicare Part B
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
POS
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
PPO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield
Workers Comp
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
EPO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
HMO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
Medicaid
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
Medicare Part A
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
Medicare Part B
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
POS
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
PPO
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
blue cross blue shield - medicare advantage
Workers Comp
O
168.00
51.31
79.34
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
EPO
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
HMO
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
Medicaid
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
Medicare Part A
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
Medicare Part B
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
POS
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
PPO
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
cigna
Workers Comp
O
168.00
51.31
74.39
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
EPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
HMO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
Medicaid
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
Medicare Part A
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
Medicare Part B
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
POS
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
PPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
humana - medicare advantage
Workers Comp
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
EPO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
HMO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
Medicaid
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
Medicare Part A
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
Medicare Part B
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
POS
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
PPO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
medica
Workers Comp
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
EPO
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
HMO
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
Medicaid
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
Medicare Part A
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
Medicare Part B
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
POS
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
PPO
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
tricare
Workers Comp
O
168.00
51.31
51.54
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
EPO
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
HMO
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
Medicaid
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
Medicare Part A
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
Medicare Part B
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
POS
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
PPO
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare
Workers Comp
O
168.00
51.31
126.00
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
EPO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
HMO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
Medicaid
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
Medicare Part A
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
Medicare Part B
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
POS
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
PPO
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
united healthcare - medicare advantage
Workers Comp
O
168.00
51.31
51.33
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
EPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
HMO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
Medicaid
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
Medicare Part A
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
Medicare Part B
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
POS
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
PPO
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
va
Workers Comp
O
168.00
51.31
51.31
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
EPO
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
HMO
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
Medicaid
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
Medicare Part A
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
Medicare Part B
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
POS
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
PPO
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87635
null
cpt
SARS-COV-2 COVID-19 AMP PRB
webtpa
Workers Comp
O
168.00
51.31
117.60
126.00
61.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
EPO
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
HMO
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
Medicaid
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
Medicare Part A
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
Medicare Part B
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
POS
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
PPO
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield
Workers Comp
O
124.65
1.40
13.64
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
124.65
1.40
16.67
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
EPO
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
HMO
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
Medicaid
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
Medicare Part A
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
Medicare Part B
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
POS
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
PPO
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
healthchoice
Workers Comp
O
124.65
1.40
1.40
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
EPO
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
HMO
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
Medicaid
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
Medicare Part A
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
Medicare Part B
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
POS
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
PPO
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
united healthcare
Workers Comp
O
124.65
1.40
89.04
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
EPO
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
HMO
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
Medicaid
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
Medicare Part A
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
Medicare Part B
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
POS
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
PPO
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87640
null
cpt
Detection test by nucleic acid for Staphylococcus aureus (bacteria) amplified probe technique
va
Workers Comp
O
124.65
1.40
118.72
118.72
26.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
EPO
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
HMO
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
Medicaid
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
Medicare Part A
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
Medicare Part B
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
POS
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
PPO
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
aetna
Workers Comp
O
85.70
0.96
48.94
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
EPO
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
HMO
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
Medicaid
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
Medicare Part A
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
Medicare Part B
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
POS
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
PPO
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield
Workers Comp
O
85.70
0.96
18.79
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
85.70
0.96
12.12
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
EPO
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
HMO
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
Medicaid
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
Medicare Part A
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
Medicare Part B
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
POS
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
PPO
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
healthchoice
Workers Comp
O
85.70
0.96
0.96
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
EPO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
HMO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
Medicaid
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
Medicare Part A
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
Medicare Part B
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
POS
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
PPO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
humana - medicare advantage
Workers Comp
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
EPO
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
HMO
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
Medicaid
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
Medicare Part A
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
Medicare Part B
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
POS
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
PPO
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
tricare
Workers Comp
O
85.70
0.96
35.23
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
EPO
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
HMO
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
Medicaid
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
Medicare Part A
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
Medicare Part B
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
POS
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
PPO
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
united healthcare
Workers Comp
O
85.70
0.96
61.22
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
EPO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
HMO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
Medicaid
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
Medicare Part A
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
Medicare Part B
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
POS
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
PPO
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87641
null
cpt
Detection test by nucleic acid for Staphylococcus aureus methicillin resistant (MRSA bacteria) amplified probe technique
va
Workers Comp
O
85.70
0.96
35.09
61.22
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
EPO
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
HMO
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
Medicaid
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
Medicare Part A
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
Medicare Part B
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
POS
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
PPO
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield
Workers Comp
O
149.83
32.86
79.34
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
149.83
32.86
32.86
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
EPO
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
HMO
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
Medicaid
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
Medicare Part A
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
Medicare Part B
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
POS
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
PPO
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
humana - medicare advantage
Workers Comp
O
149.83
32.86
35.09
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
EPO
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
HMO
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
Medicaid
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
Medicare Part A
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
Medicare Part B
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
POS
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
PPO
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
tricare
Workers Comp
O
149.83
32.86
37.19
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
EPO
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
HMO
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
Medicaid
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
Medicare Part A
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
Medicare Part B
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
POS
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
PPO
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
united healthcare
Workers Comp
O
149.83
32.86
100.97
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
EPO
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
HMO
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
Medicaid
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
Medicare Part A
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
Medicare Part B
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
POS
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
PPO
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87651
null
cpt
Detection test by nucleic acid for Strep (Streptococcus group A) amplified probe technique
webtpa
Workers Comp
O
149.83
32.86
94.23
100.97
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
EPO
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
HMO
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
Medicaid
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
Medicare Part A
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
Medicare Part B
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
POS
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
PPO
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
aetna
Workers Comp
O
107.96
12.03
62.62
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
EPO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
HMO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
Medicaid
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
Medicare Part A
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
Medicare Part B
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
POS
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
PPO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield
Workers Comp
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
EPO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
HMO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
Medicaid
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
POS
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
PPO
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
107.96
12.03
30.00
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
EPO
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
HMO
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
Medicaid
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
Medicare Part A
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
Medicare Part B
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
POS
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
PPO
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
cigna
Workers Comp
O
107.96
12.03
76.40
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
EPO
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
HMO
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
Medicaid
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
Medicare Part A
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
Medicare Part B
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
POS
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
PPO
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
healthchoice
Workers Comp
O
107.96
12.03
43.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
EPO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
HMO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
Medicaid
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
Medicare Part A
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
Medicare Part B
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
POS
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
PPO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana
Workers Comp
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
EPO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
HMO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
Medicaid
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
Medicare Part A
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
Medicare Part B
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
POS
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
PPO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
humana - medicare advantage
Workers Comp
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
EPO
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
HMO
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
Medicaid
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
Medicare Part A
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
Medicare Part B
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
POS
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
PPO
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
medica
Workers Comp
O
107.96
12.03
12.03
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
EPO
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
HMO
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
Medicaid
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
Medicare Part A
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
Medicare Part B
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
POS
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
PPO
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
tricare
Workers Comp
O
107.96
12.03
20.13
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
EPO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
HMO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
Medicaid
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
Medicare Part A
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
Medicare Part B
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
POS
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
PPO
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare
Workers Comp
O
107.96
12.03
77.12
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
EPO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
HMO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
Medicaid
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
Medicare Part A
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
Medicare Part B
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
POS
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
PPO
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
united healthcare - medicare advantage
Workers Comp
O
107.96
12.03
20.05
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
EPO
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
HMO
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
Medicaid
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
Medicare Part A
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
Medicare Part B
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
POS
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
PPO
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
va
Workers Comp
O
107.96
12.03
13.42
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
EPO
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
HMO
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
Medicaid
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
Medicare Part A
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
Medicare Part B
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
POS
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
PPO
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87660
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) direct probe technique
webtpa
Workers Comp
O
107.96
12.03
71.97
77.12
24.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
EPO
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
HMO
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
Medicaid
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
Medicare Part A
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
Medicare Part B
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
POS
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
PPO
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield
Workers Comp
O
143.06
35.09
36.77
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
EPO
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
HMO
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
Medicaid
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part A
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
Medicare Part B
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
POS
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
PPO
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
blue cross blue shield - medicare advantage
Workers Comp
O
143.06
35.09
42.46
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
EPO
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
HMO
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
Medicaid
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
Medicare Part A
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
Medicare Part B
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
POS
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
PPO
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
humana - medicare advantage
Workers Comp
O
143.06
35.09
35.09
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
EPO
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
HMO
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
Medicaid
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
Medicare Part A
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
Medicare Part B
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
POS
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
PPO
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
tricare
Workers Comp
O
143.06
35.09
35.23
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
EPO
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
HMO
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
Medicaid
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
Medicare Part A
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
Medicare Part B
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
POS
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
PPO
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87661
null
cpt
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite) amplified probe technique
webtpa
Workers Comp
O
143.06
35.09
95.38
95.38
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
EPO
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
HMO
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
Medicaid
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
Medicare Part A
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
Medicare Part B
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
POS
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
PPO
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
humana - medicare advantage
Workers Comp
O
228.87
35.09
35.09
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
EPO
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
HMO
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
Medicaid
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
Medicare Part A
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
Medicare Part B
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
POS
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
PPO
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
tricare
Workers Comp
O
228.87
35.09
35.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
EPO
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
HMO
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
Medicaid
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
Medicare Part A
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
Medicare Part B
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
POS
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
PPO
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87798
null
cpt
Detection test by nucleic acid for organism amplified probe technique
united healthcare
Workers Comp
O
228.87
35.09
154.23
154.23
42.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
EPO
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
HMO
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
Medicaid
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
Medicare Part A
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
Medicare Part B
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
POS
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
PPO
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
blue cross blue shield - medicare advantage
Workers Comp
O
249.31
42.84
53.26
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
EPO
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
HMO
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
Medicaid
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
Medicare Part A
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
Medicare Part B
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
POS
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
PPO
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87799
null
cpt
Detection test by nucleic acid for organism quantification
humana - medicare advantage
Workers Comp
O
249.31
42.84
42.84
53.26
149.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
EPO
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
HMO
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
Medicaid
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
Medicare Part A
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
Medicare Part B
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
POS
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
PPO
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield
Workers Comp
O
777.98
72.78
75.20
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
EPO
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
HMO
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
Medicaid
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
Medicare Part A
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
Medicare Part B
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
POS
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
PPO
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
blue cross blue shield - medicare advantage
Workers Comp
O
777.98
72.78
72.78
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
EPO
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
HMO
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
Medicaid
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
Medicare Part A
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
Medicare Part B
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
POS
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
PPO
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
cigna
Workers Comp
O
777.98
72.78
550.52
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
EPO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
HMO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
Medicaid
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
Medicare Part A
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
Medicare Part B
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
POS
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
PPO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
humana - medicare advantage
Workers Comp
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
EPO
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
HMO
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
Medicaid
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
Medicare Part A
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
Medicare Part B
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
POS
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
PPO
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
tricare
Workers Comp
O
777.98
72.78
258.51
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
EPO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
HMO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
Medicaid
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
Medicare Part A
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
Medicare Part B
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
POS
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
PPO
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
87902
null
cpt
Analysis test by nucleic acid for Hepatitis C virus
va
Workers Comp
O
777.98
72.78
257.45
550.52
308.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
EPO
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
HMO
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
Medicaid
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
Medicare Part A
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
Medicare Part B
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
POS
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
PPO
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
880
null
ms-drg
acute adjustment reaction and psychosocial dysfunction
tricare
Workers Comp
I
11485.51
2320.56
2320.56
2320.56
6891.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
EPO
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
HMO
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
Medicaid
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
Medicare Part A
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
Medicare Part B
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
POS
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
PPO
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield
Workers Comp
I
16325.70
4178.32
5974.40
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
EPO
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
HMO
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
Medicaid
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
Medicare Part A
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
Medicare Part B
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
POS
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
PPO
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
blue cross blue shield - medicare advantage
Workers Comp
I
16325.70
4178.32
6043.44
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
EPO
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
HMO
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
Medicaid
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
Medicare Part A
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
Medicare Part B
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
POS
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
PPO
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
humana - medicare advantage
Workers Comp
I
16325.70
4178.32
4178.32
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
EPO
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
HMO
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
Medicaid
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
Medicare Part A
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
Medicare Part B
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
POS
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
PPO
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
881
null
ms-drg
depressive neuroses
tricare
Workers Comp
I
16325.70
4178.32
5558.89
6043.44
9795.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
EPO
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
HMO
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
Medicaid
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
Medicare Part A
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
Medicare Part B
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
POS
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
PPO
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88108
null
cpt
Cell examination of specimen concentration technique
blue cross blue shield
Workers Comp
O
193.40
111.15
111.15
111.15
116.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
EPO
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
HMO
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
Medicaid
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
Medicare Part A
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
Medicare Part B
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
POS
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
PPO
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield
Workers Comp
O
303.20
43.82
224.60
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
EPO
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
HMO
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
Medicaid
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
Medicare Part A
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
Medicare Part B
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
POS
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
PPO
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
blue cross blue shield - medicare advantage
Workers Comp
O
303.20
43.82
66.95
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
EPO
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
HMO
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
Medicaid
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
Medicare Part A
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
Medicare Part B
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
POS
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
PPO
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88162
null
cpt
Screening examination of specimen cells extended study
humana - medicare advantage
Workers Comp
O
303.20
43.82
43.82
224.60
181.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
EPO
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
HMO
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
Medicaid
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
Medicare Part A
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
Medicare Part B
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
POS
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
PPO
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
aetna
Workers Comp
O
392.88
199.51
224.32
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
EPO
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
HMO
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
Medicaid
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
Medicare Part A
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
Medicare Part B
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
POS
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
PPO
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield
Workers Comp
O
392.88
199.51
199.51
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
EPO
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
HMO
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
Medicaid
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
Medicare Part A
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
Medicare Part B
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
POS
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
PPO
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
blue cross blue shield - medicare advantage
Workers Comp
O
392.88
199.51
238.10
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
EPO
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
HMO
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
Medicaid
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
Medicare Part A
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
Medicare Part B
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
POS
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
PPO
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
united healthcare
Workers Comp
O
392.88
199.51
280.64
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
EPO
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
HMO
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
Medicaid
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
Medicare Part A
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
Medicare Part B
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
POS
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
PPO
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88172
null
cpt
Evaluation of fine needle aspirate
va
Workers Comp
O
392.88
199.51
374.18
374.18
235.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
EPO
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
HMO
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
Medicaid
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
Medicare Part A
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
Medicare Part B
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
POS
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
PPO
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
aetna
Workers Comp
O
103.50
52.56
59.10
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
EPO
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
HMO
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
Medicaid
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
Medicare Part A
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
Medicare Part B
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
POS
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
PPO
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield
Workers Comp
O
103.50
52.56
52.56
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
EPO
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
HMO
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
Medicaid
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
Medicare Part A
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
Medicare Part B
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
POS
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
PPO
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
blue cross blue shield - medicare advantage
Workers Comp
O
103.50
52.56
62.73
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
EPO
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
HMO
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
Medicaid
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
Medicare Part A
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
Medicare Part B
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
POS
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
PPO
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
united healthcare
Workers Comp
O
103.50
52.56
73.94
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
EPO
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
HMO
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
Medicaid
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
Medicare Part A
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
Medicare Part B
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
POS
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
PPO
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88173
null
cpt
Evaluation of fine needle aspirate with interpretation and report
va
Workers Comp
O
103.50
52.56
98.58
98.58
62.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
EPO
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
HMO
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
Medicaid
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
Medicare Part A
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
Medicare Part B
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
POS
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
PPO
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
aetna
Workers Comp
O
78.62
16.03
45.60
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
EPO
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
HMO
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
Medicaid
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
Medicare Part A
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
Medicare Part B
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
POS
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
PPO
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield
Workers Comp
O
78.62
16.03
22.86
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
EPO
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
HMO
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
Medicaid
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
Medicare Part A
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
Medicare Part B
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
POS
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
PPO
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
blue cross blue shield - medicare advantage
Workers Comp
O
78.62
16.03
21.85
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
EPO
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
HMO
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
Medicaid
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
Medicare Part A
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
Medicare Part B
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
POS
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
PPO
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
cigna
Workers Comp
O
78.62
16.03
55.64
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
EPO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
HMO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
Medicaid
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
Medicare Part A
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
Medicare Part B
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
POS
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
PPO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana
Workers Comp
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
EPO
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
HMO
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
Medicaid
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
Medicare Part A
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
Medicare Part B
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
POS
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
PPO
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
humana - medicare advantage
Workers Comp
O
78.62
16.03
26.61
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
EPO
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
HMO
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
Medicaid
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
Medicare Part A
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
Medicare Part B
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
POS
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
PPO
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
tricare
Workers Comp
O
78.62
16.03
26.72
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
EPO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
HMO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
Medicaid
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
Medicare Part A
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
Medicare Part B
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
POS
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
PPO
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
united healthcare
Workers Comp
O
78.62
16.03
56.16
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
EPO
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
HMO
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
Medicaid
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
Medicare Part A
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
Medicare Part B
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
POS
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
PPO
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
va
Workers Comp
O
78.62
16.03
16.03
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
EPO
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
HMO
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
Medicaid
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
Medicare Part A
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
Medicare Part B
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
POS
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
PPO
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88175
null
cpt
Pap test automated thin layer preparation; automated system and manual rescreening
webtpa
Workers Comp
O
78.62
16.03
52.42
56.16
31.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
EPO
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
HMO
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
Medicaid
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
Medicare Part A
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
Medicare Part B
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
POS
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
PPO
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
aetna
Workers Comp
O
46.74
23.16
53.38
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
EPO
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
HMO
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
Medicaid
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
Medicare Part A
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
Medicare Part B
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
POS
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
PPO
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield
Workers Comp
O
46.74
23.16
23.16
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
EPO
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
HMO
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
Medicaid
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
Medicare Part A
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
Medicare Part B
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
POS
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
PPO
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
blue cross blue shield - medicare advantage
Workers Comp
O
46.74
23.16
28.33
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
EPO
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
HMO
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
Medicaid
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
Medicare Part A
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
Medicare Part B
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
POS
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
PPO
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
united healthcare
Workers Comp
O
46.74
23.16
33.39
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
EPO
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
HMO
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
Medicaid
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
Medicare Part A
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
Medicare Part B
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
POS
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
PPO
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88177
null
cpt
Pap test evaluation of fine needle aspirate immediate each additional evaluation episode
va
Workers Comp
O
46.74
23.16
133.56
133.56
28.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
EPO
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
HMO
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
Medicaid
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
Medicare Part A
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
Medicare Part B
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
POS
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
PPO
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
blue cross blue shield
Workers Comp
O
136.98
44.36
44.36
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
EPO
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
HMO
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
Medicaid
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
Medicare Part A
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
Medicare Part B
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
POS
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
PPO
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88184
null
cpt
Flow cytometry technique for DNA or cell analysis first marker
humana - medicare advantage
Workers Comp
O
136.98
44.36
121.47
121.47
82.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
EPO
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
HMO
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
Medicaid
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
Medicare Part A
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
Medicare Part B
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
POS
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
PPO
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88185
null
cpt
Flow cytometry technique for DNA or cell analysis each additional marker
blue cross blue shield
Workers Comp
O
30.00
8.87
8.87
8.87
18.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
EPO
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
HMO
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
Medicaid
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
Medicare Part A
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
Medicare Part B
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
POS
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
PPO
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
882
null
ms-drg
neuroses except depressive
tricare
Workers Comp
I
16363.71
3970.63
3970.63
3970.63
9818.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
EPO
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
HMO
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
Medicaid
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
Medicare Part A
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
Medicare Part B
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
POS
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
PPO
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88271
null
cpt
DNA testing for genetic defects
aetna - medicare advantage
Workers Comp
O
107.10
42.03
42.03
42.03
64.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
EPO
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
HMO
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
Medicaid
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
Medicare Part A
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
Medicare Part B
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
POS
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
PPO
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88275
null
cpt
Chromosome analysis for genetic defects analyze 100-300 cells
aetna - medicare advantage
Workers Comp
O
127.98
50.22
50.22
50.22
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
EPO
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
HMO
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
Medicaid
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
Medicare Part A
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
Medicare Part B
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
POS
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
PPO
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
883
null
ms-drg
disorders of personality and impulse control
blue cross blue shield
Workers Comp
I
10280.55
9665.06
9665.06
9665.06
6168.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
EPO
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
HMO
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
Medicaid
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
Medicare Part A
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
Medicare Part B
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
POS
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
PPO
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
aetna
Workers Comp
O
87.92
14.81
50.99
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
EPO
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
HMO
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
Medicaid
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
Medicare Part A
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
Medicare Part B
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
POS
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
PPO
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield
Workers Comp
O
87.92
14.81
36.98
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
EPO
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
HMO
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
Medicaid
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
POS
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
PPO
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
14.81
21.80
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
EPO
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
HMO
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
Medicaid
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
Medicare Part A
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
Medicare Part B
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
POS
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
PPO
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88300
null
cpt
Pathology examination of tissue using a microscope limited examination
tricare
Workers Comp
O
87.92
14.81
14.81
50.99
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
EPO
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
HMO
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
Medicaid
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
Medicare Part A
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
Medicare Part B
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
POS
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
PPO
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield
Workers Comp
O
140.23
47.70
47.70
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
EPO
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
HMO
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
Medicaid
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
Medicare Part A
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
Medicare Part B
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
POS
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
PPO
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
blue cross blue shield - medicare advantage
Workers Comp
O
140.23
47.70
48.03
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
EPO
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
HMO
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
Medicaid
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
Medicare Part A
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
Medicare Part B
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
POS
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
PPO
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88302
null
cpt
Pathology examination of tissue using a microscope
va
Workers Comp
O
140.23
47.70
133.56
133.56
84.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
EPO
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
HMO
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
Medicaid
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
Medicare Part A
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
Medicare Part B
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
POS
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
PPO
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
aetna
Workers Comp
O
200.34
43.82
116.20
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
EPO
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
HMO
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
Medicaid
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
Medicare Part A
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
Medicare Part B
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
POS
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
PPO
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield
Workers Comp
O
200.34
43.82
65.45
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
EPO
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
HMO
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
Medicaid
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
Medicare Part A
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
Medicare Part B
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
POS
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
PPO
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
blue cross blue shield - medicare advantage
Workers Comp
O
200.34
43.82
64.75
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
EPO
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
HMO
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
Medicaid
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
Medicare Part A
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
Medicare Part B
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
POS
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
PPO
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
cigna
Workers Comp
O
200.34
43.82
141.76
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
EPO
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
HMO
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
Medicaid
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
Medicare Part A
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
Medicare Part B
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
POS
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
PPO
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
humana - medicare advantage
Workers Comp
O
200.34
43.82
43.82
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
EPO
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
HMO
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
Medicaid
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
Medicare Part A
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
Medicare Part B
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
POS
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
PPO
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
united healthcare
Workers Comp
O
200.34
43.82
143.10
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
EPO
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
HMO
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
Medicaid
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
Medicare Part A
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
Medicare Part B
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
POS
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
PPO
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
va
Workers Comp
O
200.34
43.82
200.34
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
EPO
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
HMO
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
Medicaid
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
Medicare Part A
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
Medicare Part B
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
POS
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
PPO
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88304
null
cpt
Pathology examination of tissue using a microscope moderately low complexity
webtpa
Workers Comp
O
200.34
43.82
133.56
200.34
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
EPO
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
HMO
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
Medicaid
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
Medicare Part A
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
Medicare Part B
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
POS
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
PPO
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
aetna
Workers Comp
O
238.18
32.09
138.14
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
EPO
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
HMO
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
Medicaid
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
Medicare Part A
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
Medicare Part B
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
POS
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
PPO
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield
Workers Comp
O
238.18
32.09
99.37
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
EPO
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
HMO
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
Medicaid
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
POS
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
PPO
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
32.09
91.41
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
EPO
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
HMO
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
Medicaid
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
Medicare Part A
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
Medicare Part B
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
POS
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
PPO
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
cigna
Workers Comp
O
238.18
32.09
159.02
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
EPO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
HMO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
Medicaid
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
Medicare Part A
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
Medicare Part B
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
POS
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
PPO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
geha
Workers Comp
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
EPO
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
HMO
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
Medicaid
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
Medicare Part A
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
Medicare Part B
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
POS
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
PPO
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
healthchoice
Workers Comp
O
238.18
32.09
32.09
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
EPO
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
HMO
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
Medicaid
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
Medicare Part A
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
Medicare Part B
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
POS
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
PPO
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
humana - medicare advantage
Workers Comp
O
238.18
32.09
43.45
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
EPO
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
HMO
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
Medicaid
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
Medicare Part A
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
Medicare Part B
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
POS
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
PPO
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
medica
Workers Comp
O
238.18
32.09
88.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
EPO
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
HMO
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
Medicaid
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
Medicare Part A
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
Medicare Part B
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
POS
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
PPO
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
tricare
Workers Comp
O
238.18
32.09
43.82
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
EPO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
HMO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
Medicaid
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
Medicare Part A
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
Medicare Part B
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
POS
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
PPO
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
united healthcare
Workers Comp
O
238.18
32.09
170.13
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
EPO
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
HMO
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
Medicaid
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
Medicare Part A
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
Medicare Part B
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
POS
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
PPO
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
va
Workers Comp
O
238.18
32.09
226.84
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
EPO
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
HMO
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
Medicaid
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
Medicare Part A
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
Medicare Part B
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
POS
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
PPO
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88305
null
cpt
Pathology examination of tissue using a microscope intermediate complexity
webtpa
Workers Comp
O
238.18
32.09
158.79
226.84
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
EPO
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
HMO
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
Medicaid
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
Medicare Part A
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
Medicare Part B
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
POS
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
PPO
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
aetna
Workers Comp
O
281.58
86.07
170.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
EPO
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
HMO
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
Medicaid
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
Medicare Part A
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
Medicare Part B
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
POS
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
PPO
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield
Workers Comp
O
281.58
86.07
99.51
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
EPO
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
HMO
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
Medicaid
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
Medicare Part A
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
Medicare Part B
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
POS
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
PPO
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
blue cross blue shield - medicare advantage
Workers Comp
O
281.58
86.07
86.07
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
EPO
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
HMO
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
Medicaid
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
Medicare Part A
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
Medicare Part B
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
POS
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
PPO
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
cigna
Workers Comp
O
281.58
86.07
187.99
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
EPO
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
HMO
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
Medicaid
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
Medicare Part A
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
Medicare Part B
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
POS
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
PPO
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
geha
Workers Comp
O
281.58
86.07
201.13
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
EPO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
HMO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
Medicaid
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
Medicare Part A
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
Medicare Part B
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
POS
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
PPO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
humana - medicare advantage
Workers Comp
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
EPO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
HMO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
Medicaid
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
Medicare Part A
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
Medicare Part B
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
POS
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
PPO
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
tricare
Workers Comp
O
281.58
86.07
298.47
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
EPO
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
HMO
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
Medicaid
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
Medicare Part A
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
Medicare Part B
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
POS
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
PPO
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88307
null
cpt
Pathology examination of tissue using a microscope moderately high complexity
worker comp
Workers Comp
O
281.58
86.07
201.14
298.47
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
EPO
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
HMO
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
Medicaid
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
Medicare Part A
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
Medicare Part B
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
POS
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
PPO
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
aetna
Workers Comp
O
656.67
235.90
396.76
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
EPO
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
HMO
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
Medicaid
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
Medicare Part A
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
Medicare Part B
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
POS
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
PPO
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield
Workers Comp
O
656.67
235.90
248.48
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
EPO
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
HMO
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
Medicaid
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
Medicare Part A
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
Medicare Part B
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
POS
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
PPO
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
blue cross blue shield - medicare advantage
Workers Comp
O
656.67
235.90
235.90
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
EPO
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
HMO
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
Medicaid
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
Medicare Part A
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
Medicare Part B
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
POS
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
PPO
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88309
null
cpt
Pathology examination of tissue using a microscope high complexity
humana - medicare advantage
Workers Comp
O
656.67
235.90
473.07
473.07
394.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
EPO
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
HMO
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
Medicaid
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
Medicare Part A
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
Medicare Part B
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
POS
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
PPO
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield
Workers Comp
O
43.40
12.25
15.76
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
EPO
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
HMO
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
Medicaid
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
Medicare Part A
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
Medicare Part B
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
POS
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
PPO
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
blue cross blue shield - medicare advantage
Workers Comp
O
43.40
12.25
12.25
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
EPO
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
HMO
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
Medicaid
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
Medicare Part A
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
Medicare Part B
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
POS
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
PPO
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88311
null
cpt
Preparation of tissue for examination by removing any calcium present
va
Workers Comp
O
43.40
12.25
43.40
43.40
26.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
EPO
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
HMO
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
Medicaid
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
Medicare Part A
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
Medicare Part B
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
POS
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
PPO
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield
Workers Comp
O
60.10
21.60
22.71
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
EPO
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
HMO
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
Medicaid
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part A
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part B
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
POS
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
PPO
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88312
null
cpt
Special stained specimen slides to identify organisms including interpretation and report
blue cross blue shield - medicare advantage
Workers Comp
O
60.10
21.60
21.60
22.71
36.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
EPO
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
HMO
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
Medicaid
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
Medicare Part A
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
Medicare Part B
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
POS
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
PPO
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
aetna
Workers Comp
O
112.41
41.41
65.20
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
EPO
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
HMO
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
Medicaid
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
Medicare Part A
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
Medicare Part B
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
POS
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
PPO
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield
Workers Comp
O
112.41
41.41
47.57
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
EPO
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
HMO
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
Medicaid
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part A
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part B
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
POS
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
PPO
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88313
null
cpt
Special stained specimen slides to examine tissue including interpretation and report
blue cross blue shield - medicare advantage
Workers Comp
O
112.41
41.41
41.41
65.20
67.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
EPO
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
HMO
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
Medicaid
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
Medicare Part A
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
Medicare Part B
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
POS
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
PPO
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88329
null
cpt
Pathology examination of specimen during surgery
blue cross blue shield
Workers Comp
O
166.34
56.18
56.18
56.18
99.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
EPO
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
HMO
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
Medicaid
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
Medicare Part A
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
Medicare Part B
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
POS
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
PPO
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
aetna
Workers Comp
O
438.52
159.32
254.34
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
EPO
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
HMO
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
Medicaid
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
Medicare Part A
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
Medicare Part B
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
POS
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
PPO
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield
Workers Comp
O
438.52
159.32
161.96
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
EPO
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
HMO
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
Medicaid
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
Medicare Part A
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
Medicare Part B
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
POS
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
PPO
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88331
null
cpt
Pathology examination of specimen during surgery first tissue block
blue cross blue shield - medicare advantage
Workers Comp
O
438.52
159.32
159.32
254.34
263.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
EPO
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
HMO
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
Medicaid
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
Medicare Part A
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
Medicare Part B
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
POS
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
PPO
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
blue cross blue shield
Workers Comp
O
156.93
24.35
24.35
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
EPO
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
HMO
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
Medicaid
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
Medicare Part A
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
Medicare Part B
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
POS
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
PPO
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88333
null
cpt
Pathology cytologic examination of specimen during surgery initial site
tricare
Workers Comp
O
156.93
24.35
166.34
166.34
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
EPO
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
HMO
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
Medicaid
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
Medicare Part A
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
Medicare Part B
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
POS
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
PPO
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
aetna
Workers Comp
O
117.97
17.97
71.27
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
EPO
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
HMO
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
Medicaid
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
Medicare Part A
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
Medicare Part B
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
POS
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
PPO
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield
Workers Comp
O
117.97
17.97
17.97
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
EPO
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
HMO
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
Medicaid
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
POS
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
PPO
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
blue cross blue shield - medicare advantage
Workers Comp
O
117.97
17.97
30.40
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
EPO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
HMO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
Medicaid
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
Medicare Part A
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
Medicare Part B
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
POS
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
PPO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
humana - medicare advantage
Workers Comp
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
EPO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
HMO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
Medicaid
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
Medicare Part A
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
Medicare Part B
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
POS
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
PPO
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88341
null
cpt
Special stained specimen slides to examine tissue each additional procedure
tricare
Workers Comp
O
117.97
17.97
125.04
125.04
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
EPO
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
HMO
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
Medicaid
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
Medicare Part A
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
Medicare Part B
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
POS
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
PPO
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
aetna
Workers Comp
O
396.22
33.03
229.81
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
EPO
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
HMO
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
Medicaid
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
Medicare Part A
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
Medicare Part B
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
POS
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
PPO
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield
Workers Comp
O
396.22
33.03
156.41
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
EPO
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
HMO
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
Medicaid
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
POS
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
PPO
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
blue cross blue shield - medicare advantage
Workers Comp
O
396.22
33.03
153.37
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
EPO
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
HMO
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
Medicaid
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
Medicare Part A
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
Medicare Part B
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
POS
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
PPO
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
cigna
Workers Comp
O
396.22
33.03
272.46
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
EPO
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
HMO
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
Medicaid
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
Medicare Part A
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
Medicare Part B
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
POS
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
PPO
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
tricare
Workers Comp
O
396.22
33.03
33.03
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
EPO
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
HMO
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
Medicaid
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
Medicare Part A
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
Medicare Part B
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
POS
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
PPO
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
united healthcare
Workers Comp
O
396.22
33.03
283.02
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
EPO
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
HMO
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
Medicaid
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
Medicare Part A
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
Medicare Part B
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
POS
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
PPO
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88342
null
cpt
Special stained specimen slides to examine tissue initial procedure
va
Workers Comp
O
396.22
33.03
377.36
377.36
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
EPO
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
HMO
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
Medicaid
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
Medicare Part A
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
Medicare Part B
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
POS
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
PPO
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88344
null
cpt
Special stained specimen slides to examine tissue each multiplex procedure
humana - medicare advantage
Workers Comp
O
396.22
335.53
335.53
335.53
290.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
EPO
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
HMO
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
Medicaid
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
Medicare Part A
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
Medicare Part B
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
POS
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
PPO
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
aetna
Workers Comp
O
312.75
115.17
188.96
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
EPO
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
HMO
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
Medicaid
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
Medicare Part A
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
Medicare Part B
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
POS
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
PPO
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield
Workers Comp
O
312.75
115.17
129.15
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
EPO
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
HMO
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
Medicaid
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
Medicare Part A
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
Medicare Part B
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
POS
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
PPO
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
blue cross blue shield - medicare advantage
Workers Comp
O
312.75
115.17
115.17
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
EPO
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
HMO
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
Medicaid
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
Medicare Part A
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
Medicare Part B
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
POS
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
PPO
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88360
null
cpt
Microscopic genetic analysis of tumor manual
humana - medicare advantage
Workers Comp
O
312.75
115.17
181.33
188.96
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
EPO
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
HMO
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
Medicaid
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
Medicare Part A
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
Medicare Part B
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
POS
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
PPO
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield
Workers Comp
O
268.18
59.12
102.58
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
EPO
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
HMO
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
Medicaid
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
Medicare Part A
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
Medicare Part B
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
POS
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
PPO
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
blue cross blue shield - medicare advantage
Workers Comp
O
268.18
59.12
112.67
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
EPO
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
HMO
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
Medicaid
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
Medicare Part A
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
Medicare Part B
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
POS
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
PPO
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88361
null
cpt
Microscopic genetic analysis of tumor using computer-assisted technology
tricare
Workers Comp
O
268.18
59.12
59.12
112.67
160.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
EPO
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
HMO
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
Medicaid
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
POS
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
PPO
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88364
null
cpt
Genetic sequencing localization each additional procedure
blue cross blue shield - medicare advantage
Workers Comp
O
287.00
37.15
37.15
37.15
172.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
EPO
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
HMO
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
Medicaid
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
Medicare Part A
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
Medicare Part B
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
POS
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
PPO
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88365
null
cpt
Genetic sequencing localization initial procedure
blue cross blue shield - medicare advantage
Workers Comp
O
317.80
41.13
41.13
41.13
190.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
EPO
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
HMO
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
Medicaid
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
Medicare Part A
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
Medicare Part B
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
POS
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
PPO
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
blue cross blue shield
Workers Comp
O
360.00
125.70
125.70
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
EPO
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
HMO
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
Medicaid
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
Medicare Part A
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
Medicare Part B
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
POS
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
PPO
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88368
null
cpt
Microscopic genetic analysis of tissue manual initial procedure
humana - medicare advantage
Workers Comp
O
360.00
125.70
295.00
295.00
216.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
EPO
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
HMO
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
Medicaid
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
Medicare Part A
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
Medicare Part B
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
POS
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
PPO
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88377
null
cpt
Microscopic genetic analysis of tissue manual each additional multiplex stain procedure
blue cross blue shield
Workers Comp
O
850.00
209.50
209.50
209.50
510.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
EPO
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
HMO
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
Medicaid
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
Medicare Part A
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
Medicare Part B
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
POS
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
PPO
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
blue cross blue shield
Workers Comp
I
26419.84
4867.70
9991.17
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
EPO
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
HMO
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
Medicaid
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
Medicare Part A
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
Medicare Part B
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
POS
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
PPO
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
884
null
ms-drg
organic disturbances and intellectual disability
humana - medicare advantage
Workers Comp
I
26419.84
4867.70
4867.70
9991.17
15851.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
EPO
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
HMO
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
Medicaid
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
Medicare Part A
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
Medicare Part B
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
POS
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
PPO
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
aetna
Workers Comp
I
17156.31
4764.76
6861.23
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
EPO
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
HMO
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
Medicaid
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
Medicare Part A
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
Medicare Part B
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
POS
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
PPO
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield
Workers Comp
I
17156.31
4764.76
9001.82
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
EPO
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
HMO
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
Medicaid
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
Medicare Part A
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
Medicare Part B
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
POS
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
PPO
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
blue cross blue shield - medicare advantage
Workers Comp
I
17156.31
4764.76
7350.71
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
EPO
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
HMO
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
Medicaid
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
Medicare Part A
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
Medicare Part B
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
POS
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
PPO
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
humana - medicare advantage
Workers Comp
I
17156.31
4764.76
7754.70
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
EPO
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
HMO
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
Medicaid
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
Medicare Part A
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
Medicare Part B
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
POS
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
PPO
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
tricare
Workers Comp
I
17156.31
4764.76
4764.76
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
EPO
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
HMO
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
Medicaid
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
Medicare Part A
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
Medicare Part B
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
POS
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
PPO
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
885
null
ms-drg
psychoses
va
Workers Comp
I
17156.31
4764.76
6732.11
9001.82
10293.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
EPO
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
HMO
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
Medicaid
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
Medicare Part A
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
Medicare Part B
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
POS
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
PPO
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
88720
null
cpt
Measurement of bilirubin
tricare
Workers Comp
O
117.60
5.04
5.04
5.04
70.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
EPO
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
HMO
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
Medicaid
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
Medicare Part A
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
Medicare Part B
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
POS
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
PPO
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
aetna
Workers Comp
O
40.17
5.60
38.26
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
EPO
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
HMO
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
Medicaid
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
Medicare Part A
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
Medicare Part B
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
POS
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
PPO
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
blue cross blue shield
Workers Comp
O
40.17
5.60
16.39
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
EPO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
HMO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
Medicaid
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
Medicare Part A
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
Medicare Part B
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
POS
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
PPO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
humana - medicare advantage
Workers Comp
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
EPO
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
HMO
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
Medicaid
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
Medicare Part A
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
Medicare Part B
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
POS
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
PPO
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
tricare
Workers Comp
O
40.17
5.60
5.62
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
EPO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
HMO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
Medicaid
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
Medicare Part A
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
Medicare Part B
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
POS
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
PPO
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89051
null
cpt
Body fluid cell count with cell identification
va
Workers Comp
O
40.17
5.60
5.60
38.26
6.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
EPO
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
HMO
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
Medicaid
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
Medicare Part A
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
Medicare Part B
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
POS
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
PPO
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
aetna
Workers Comp
O
37.84
7.33
36.04
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
EPO
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
HMO
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
Medicaid
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
Medicare Part A
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
Medicare Part B
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
POS
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
PPO
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
blue cross blue shield
Workers Comp
O
37.84
7.33
15.44
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
EPO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
HMO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
Medicaid
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
Medicare Part A
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
Medicare Part B
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
POS
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
PPO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
humana - medicare advantage
Workers Comp
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
EPO
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
HMO
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
Medicaid
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
Medicare Part A
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
Medicare Part B
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
POS
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
PPO
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
tricare
Workers Comp
O
37.84
7.33
7.67
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
EPO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
HMO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
Medicaid
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
Medicare Part A
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
Medicare Part B
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
POS
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
PPO
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89060
null
cpt
Crystal identification from tissue or body fluid
va
Workers Comp
O
37.84
7.33
7.33
36.04
8.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
EPO
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
HMO
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
Medicaid
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
Medicare Part A
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
Medicare Part B
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
POS
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
PPO
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
tricare
Workers Comp
O
127.99
12.31
12.36
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
EPO
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
HMO
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
Medicaid
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
Medicare Part A
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
Medicare Part B
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
POS
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
PPO
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89320
null
cpt
Semen evaluation volume sperm count motility and analysis
va
Workers Comp
O
127.99
12.31
12.31
12.36
76.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
EPO
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
HMO
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
Medicaid
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
Medicare Part A
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
Medicare Part B
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
POS
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
PPO
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
89321
null
cpt
Semen analysis for sperm presence
blue cross blue shield
Workers Comp
O
70.78
65.59
65.59
65.59
42.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
EPO
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
HMO
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
Medicaid
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
Medicare Part A
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
Medicare Part B
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
POS
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
PPO
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
894
null
ms-drg
alcohol drug abuse or dependence left ama
va
Workers Comp
I
9809.89
4398.67
4398.67
4398.67
5885.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
EPO
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
HMO
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
Medicaid
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
Medicare Part A
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
Medicare Part B
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
POS
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
PPO
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
aetna
Workers Comp
I
26042.50
10655.83
10655.83
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
EPO
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
HMO
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
Medicaid
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
Medicare Part A
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
Medicare Part B
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
POS
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
PPO
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
896
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy with mcc
va
Workers Comp
I
26042.50
10655.83
13359.64
13359.64
15625.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
EPO
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
HMO
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
Medicaid
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
Medicare Part A
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
Medicare Part B
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
POS
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
PPO
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield
Workers Comp
I
15713.25
3026.54
5610.98
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
EPO
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
HMO
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
Medicaid
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
POS
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
PPO
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
15713.25
3026.54
8883.00
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
EPO
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
HMO
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
Medicaid
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
Medicare Part A
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
Medicare Part B
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
POS
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
PPO
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
humana - medicare advantage
Workers Comp
I
15713.25
3026.54
4477.46
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
EPO
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
HMO
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
Medicaid
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
Medicare Part A
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
Medicare Part B
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
POS
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
PPO
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
tricare
Workers Comp
I
15713.25
3026.54
3026.54
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
EPO
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
HMO
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
Medicaid
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
Medicare Part A
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
Medicare Part B
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
POS
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
PPO
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
va
Workers Comp
I
15713.25
3026.54
5569.31
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
EPO
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
HMO
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
Medicaid
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
Medicare Part A
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
Medicare Part B
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
POS
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
PPO
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
897
null
ms-drg
alcohol drug abuse or dependence without rehabilitation therapy without mcc
webtpa
Workers Comp
I
15713.25
3026.54
4856.90
8883.00
9427.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
EPO
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
HMO
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
Medicaid
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
Medicare Part A
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
Medicare Part B
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
POS
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
PPO
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
blue cross blue shield - medicare advantage
Workers Comp
O
124.95
18.90
38.89
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
EPO
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
HMO
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
Medicaid
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
Medicare Part A
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
Medicare Part B
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
POS
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
PPO
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
humana - medicare advantage
Workers Comp
O
124.95
18.90
18.90
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
EPO
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
HMO
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
Medicaid
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
Medicare Part A
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
Medicare Part B
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
POS
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
PPO
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90686
null
cpt
Vaccine for influenza for administration into muscle 0.5 ml dosage quadrivalent preservation free
tricare
Workers Comp
O
124.95
18.90
19.03
38.89
74.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
EPO
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
HMO
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
Medicaid
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
Medicare Part A
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
Medicare Part B
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
POS
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
PPO
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna
Workers Comp
O
183.00
24.05
24.05
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
EPO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
HMO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
Medicaid
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
Medicare Part A
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
Medicare Part B
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
POS
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
PPO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
aetna - medicare advantage
Workers Comp
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
EPO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
HMO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
Medicaid
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
Medicare Part A
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
Medicare Part B
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
POS
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
PPO
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90694
null
cpt
Influenza virus vaccine quadrivalent (aIIV4) inactivated adjuvanted preservative free for injection into muscle 0.5 ml dosage
humana - medicare advantage
Workers Comp
O
183.00
24.05
24.71
24.71
109.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
EPO
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
HMO
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
Medicaid
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
Medicare Part A
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
Medicare Part B
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
POS
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
PPO
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
blue cross blue shield - medicare advantage
Workers Comp
O
145.22
20.58
31.64
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
EPO
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
HMO
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
Medicaid
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
Medicare Part A
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
Medicare Part B
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
POS
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
PPO
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
humana - medicare advantage
Workers Comp
O
145.22
20.58
20.58
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
EPO
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
HMO
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
Medicaid
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
Medicare Part A
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
Medicare Part B
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
POS
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
PPO
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
90732
null
cpt
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle patient 2 years or older
va
Workers Comp
O
145.22
20.58
25.54
31.64
87.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
EPO
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
HMO
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
Medicaid
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
Medicare Part A
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
Medicare Part B
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
POS
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
PPO
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
blue cross blue shield
Workers Comp
I
62875.35
11256.03
17222.48
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
EPO
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
HMO
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
Medicaid
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
Medicare Part A
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
Medicare Part B
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
POS
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
PPO
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
908
null
ms-drg
other o.r. procedures for injuries with cc
humana - medicare advantage
Workers Comp
I
62875.35
11256.03
11256.03
17222.48
37725.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
EPO
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
HMO
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
Medicaid
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
Medicare Part A
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
Medicare Part B
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
POS
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
PPO
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
blue cross blue shield
Workers Comp
O
2778.53
371.21
430.40
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
EPO
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
HMO
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
Medicaid
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
Medicare Part A
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
Medicare Part B
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
POS
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
PPO
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
humana - medicare advantage
Workers Comp
O
2778.53
371.21
371.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
EPO
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
HMO
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
Medicaid
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
Medicare Part A
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
Medicare Part B
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
POS
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
PPO
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
tricare
Workers Comp
O
2778.53
371.21
666.21
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
EPO
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
HMO
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
Medicaid
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
Medicare Part A
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
Medicare Part B
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
POS
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
PPO
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91010
null
cpt
Measurement of esophageal swallowing movement
va
Workers Comp
O
2778.53
371.21
666.18
666.21
1667.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
EPO
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
HMO
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
Medicaid
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
Medicare Part A
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
Medicare Part B
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
POS
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
PPO
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
blue cross blue shield
Workers Comp
O
5215.15
545.18
545.18
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
EPO
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
HMO
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
Medicaid
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
Medicare Part A
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
Medicare Part B
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
POS
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
PPO
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
humana - medicare advantage
Workers Comp
O
5215.15
545.18
1149.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
EPO
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
HMO
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
Medicaid
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
Medicare Part A
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
Medicare Part B
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
POS
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
PPO
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91035
null
cpt
Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation
tricare
Workers Comp
O
5215.15
545.18
717.01
1149.01
3129.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
EPO
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
HMO
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
Medicaid
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
Medicare Part A
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
Medicare Part B
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
POS
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
PPO
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
humana - medicare advantage
Workers Comp
O
2795.04
371.21
371.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
EPO
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
HMO
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
Medicaid
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
Medicare Part A
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
Medicare Part B
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
POS
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
PPO
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
tricare
Workers Comp
O
2795.04
371.21
666.21
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
EPO
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
HMO
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
Medicaid
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
Medicare Part A
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
Medicare Part B
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
POS
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
PPO
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91037
null
cpt
Monitoring of gastroesophageal reflux including analysis and interpretation
va
Workers Comp
O
2795.04
371.21
666.18
666.21
1677.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
EPO
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
HMO
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
Medicaid
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
Medicare Part A
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
Medicare Part B
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
POS
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
PPO
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
91110
null
cpt
Imaging of digestive tract done from the inside of the digestive tract
humana - medicare advantage
Workers Comp
O
2144.07
537.76
537.76
537.76
1286.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
EPO
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
HMO
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
Medicaid
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
Medicare Part A
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
Medicare Part B
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
POS
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
PPO
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield
Workers Comp
O
237.44
74.08
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
EPO
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
HMO
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
Medicaid
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
Medicare Part A
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
Medicare Part B
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
POS
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
PPO
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
blue cross blue shield - medicare advantage
Workers Comp
O
237.44
74.08
87.86
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
EPO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
HMO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
Medicaid
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
Medicare Part A
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
Medicare Part B
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
POS
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
PPO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
humana - medicare advantage
Workers Comp
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
EPO
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
HMO
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
Medicaid
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
Medicare Part A
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
Medicare Part B
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
POS
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
PPO
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
tricare
Workers Comp
O
237.44
74.08
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
EPO
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
HMO
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
Medicaid
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
Medicare Part A
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
Medicare Part B
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
POS
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
PPO
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
united healthcare
Workers Comp
O
237.44
74.08
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
EPO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
HMO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
Medicaid
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
Medicare Part A
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
Medicare Part B
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
POS
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
PPO
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92507
null
cpt
Treatment of speech language voice communication and/or hearing processing disorder
va
Workers Comp
O
237.44
74.08
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92523
null
cpt
Evaluation of speech sound production with evaluation of language comprehension and expression
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
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
EPO
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
HMO
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
Medicaid
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
Medicare Part A
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
Medicare Part B
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
POS
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
PPO
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
aetna
Workers Comp
O
384.64
81.63
232.39
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
EPO
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
HMO
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
Medicaid
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
Medicare Part A
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
Medicare Part B
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
POS
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
PPO
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
blue cross blue shield
Workers Comp
O
384.64
81.63
122.74
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
EPO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
HMO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
Medicaid
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
Medicare Part A
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
Medicare Part B
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
POS
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
PPO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
humana - medicare advantage
Workers Comp
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
EPO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
HMO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
Medicaid
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
Medicare Part A
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
Medicare Part B
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
POS
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
PPO
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92526
null
cpt
Treatment of swallowing and/or oral feeding function
va
Workers Comp
O
384.64
81.63
81.63
232.39
230.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
EPO
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
HMO
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
Medicaid
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
Medicare Part A
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
Medicare Part B
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
POS
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
PPO
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
blue cross blue shield
Workers Comp
O
270.22
81.46
93.16
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
EPO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
HMO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
Medicaid
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
Medicare Part A
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
Medicare Part B
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
POS
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
PPO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
humana - medicare advantage
Workers Comp
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
EPO
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
HMO
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
Medicaid
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
Medicare Part A
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
Medicare Part B
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
POS
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
PPO
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
tricare
Workers Comp
O
270.22
81.46
84.11
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
EPO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
HMO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
Medicaid
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
Medicare Part A
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
Medicare Part B
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
POS
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
PPO
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92610
null
cpt
Evaluation of swallowing function
va
Workers Comp
O
270.22
81.46
81.46
93.16
162.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
EPO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
HMO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
Medicaid
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
Medicare Part A
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
Medicare Part B
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
POS
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
PPO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield
Workers Comp
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
EPO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
HMO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicaid
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicare Part A
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
Medicare Part B
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
POS
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
PPO
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
blue cross blue shield - medicare advantage
Workers Comp
O
310.29
87.95
105.98
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
EPO
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
HMO
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
Medicaid
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
Medicare Part A
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
Medicare Part B
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
POS
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
PPO
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
humana - medicare advantage
Workers Comp
O
310.29
87.95
88.59
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
EPO
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
HMO
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
Medicaid
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
Medicare Part A
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
Medicare Part B
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
POS
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
PPO
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
tricare
Workers Comp
O
310.29
87.95
89.23
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
EPO
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
HMO
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
Medicaid
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
Medicare Part A
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
Medicare Part B
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
POS
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
PPO
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92611
null
cpt
Fluoroscopic and video recorded motion evaluation of swallowing function
va
Workers Comp
O
310.29
87.95
87.95
105.98
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
EPO
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
HMO
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
Medicaid
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
Medicare Part A
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
Medicare Part B
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
POS
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
PPO
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
aetna
Workers Comp
O
47760.49
4389.98
4389.98
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
EPO
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
HMO
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
Medicaid
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
Medicare Part A
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
Medicare Part B
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
POS
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
PPO
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
blue cross blue shield - medicare advantage
Workers Comp
O
47760.49
4389.98
25971.62
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
EPO
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
HMO
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
Medicaid
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
Medicare Part A
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
Medicare Part B
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
POS
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
PPO
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
humana - medicare advantage
Workers Comp
O
47760.49
4389.98
4468.10
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
EPO
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
HMO
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
Medicaid
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
Medicare Part A
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
Medicare Part B
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
POS
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
PPO
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92920
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) each additional artery or branch
va
Workers Comp
O
47760.49
4389.98
8907.52
25971.62
28656.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
EPO
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
HMO
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
Medicaid
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
Medicare Part A
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
Medicare Part B
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
POS
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
PPO
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
aetna
Workers Comp
O
71846.71
8557.96
8894.43
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
EPO
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
HMO
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
Medicaid
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
Medicare Part A
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
Medicare Part B
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
POS
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
PPO
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
humana - medicare advantage
Workers Comp
O
71846.71
8557.96
14120.90
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
EPO
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
HMO
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
Medicaid
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
Medicare Part A
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
Medicare Part B
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
POS
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
PPO
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
tricare
Workers Comp
O
71846.71
8557.96
8557.96
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
EPO
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
HMO
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
Medicaid
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
Medicare Part A
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
Medicare Part B
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
POS
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
PPO
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92921
null
cpt
Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) single artery or branch
va
Workers Comp
O
71846.71
8557.96
8894.13
14120.90
43108.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
EPO
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
HMO
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
Medicaid
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
Medicare Part A
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
Medicare Part B
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
POS
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
PPO
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
blue cross blue shield
Workers Comp
O
760.17
310.35
310.35
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
EPO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
HMO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
Medicaid
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
Medicare Part A
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
Medicare Part B
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
POS
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
PPO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
humana - medicare advantage
Workers Comp
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
EPO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
HMO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
Medicaid
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
Medicare Part A
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
Medicare Part B
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
POS
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
PPO
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92960
null
cpt
External shock to heart to regulate heart beat
tricare
Workers Comp
O
760.17
310.35
475.24
475.24
456.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
EPO
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
HMO
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
Medicaid
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
Medicare Part A
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
Medicare Part B
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
POS
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
PPO
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
aetna - medicare advantage
Workers Comp
O
78124.15
8907.52
14120.90
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
EPO
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
HMO
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
Medicaid
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
Medicare Part A
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
Medicare Part B
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
POS
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
PPO
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
humana - medicare advantage
Workers Comp
O
78124.15
8907.52
11449.31
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
EPO
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
HMO
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
Medicaid
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
Medicare Part A
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
Medicare Part B
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
POS
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
PPO
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
tricare
Workers Comp
O
78124.15
8907.52
14173.91
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
EPO
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
HMO
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
Medicaid
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
Medicare Part A
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
Medicare Part B
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
POS
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
PPO
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92978
null
cpt
Ultrasound evaluation of heart blood vessel or graft initial vessel
va
Workers Comp
O
78124.15
8907.52
8907.52
14173.91
46874.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
EPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
HMO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
Medicaid
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
Medicare Part A
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
Medicare Part B
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
POS
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
PPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
aetna - medicare advantage
Workers Comp
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
EPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
HMO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
Medicaid
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
Medicare Part A
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
Medicare Part B
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
POS
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
PPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
humana - medicare advantage
Workers Comp
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
EPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
HMO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
Medicaid
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
Medicare Part A
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
Medicare Part B
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
POS
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
PPO
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
tricare
Workers Comp
O
95713.44
11507.52
14120.90
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
EPO
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
HMO
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
Medicaid
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
Medicare Part A
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
Medicare Part B
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
POS
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
PPO
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
92979
null
cpt
Ultrasound evaluation of heart blood vessel or graft each additional vessel
va
Workers Comp
O
95713.44
11507.52
11507.52
14120.90
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
EPO
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
HMO
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
Medicaid
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
Medicare Part A
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
Medicare Part B
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
POS
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
PPO
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna
Workers Comp
O
205.90
39.63
119.42
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
EPO
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
HMO
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
Medicaid
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
Medicare Part A
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
Medicare Part B
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
POS
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
PPO
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
aetna - medicare advantage
Workers Comp
O
205.90
39.63
49.01
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
EPO
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
HMO
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
Medicaid
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
Medicare Part A
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
Medicare Part B
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
POS
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
PPO
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield
Workers Comp
O
205.90
39.63
45.40
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
EPO
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
HMO
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
Medicaid
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
Medicare Part A
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
Medicare Part B
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
POS
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
PPO
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
blue cross blue shield - medicare advantage
Workers Comp
O
205.90
39.63
40.78
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
EPO
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
HMO
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
Medicaid
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
Medicare Part A
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
Medicare Part B
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
POS
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
PPO
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
cigna
Workers Comp
O
205.90
39.63
145.70
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
EPO
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
HMO
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
Medicaid
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
Medicare Part A
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
Medicare Part B
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
POS
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
PPO
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
geha
Workers Comp
O
205.90
39.63
147.07
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
EPO
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
HMO
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
Medicaid
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
Medicare Part A
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
Medicare Part B
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
POS
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
PPO
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
healthchoice
Workers Comp
O
205.90
39.63
39.63
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
EPO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
HMO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
Medicaid
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
Medicare Part A
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
Medicare Part B
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
POS
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
PPO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
humana - medicare advantage
Workers Comp
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
EPO
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
HMO
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
Medicaid
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
Medicare Part A
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
Medicare Part B
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
POS
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
PPO
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
medica
Workers Comp
O
205.90
39.63
76.18
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
EPO
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
HMO
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
Medicaid
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
Medicare Part A
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
Medicare Part B
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
POS
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
PPO
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
tricare
Workers Comp
O
205.90
39.63
48.73
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
EPO
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
HMO
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
Medicaid
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
Medicare Part A
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
Medicare Part B
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
POS
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
PPO
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare
Workers Comp
O
205.90
39.63
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
EPO
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
HMO
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
Medicaid
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
Medicare Part A
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
Medicare Part B
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
POS
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
PPO
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
united healthcare - medicare advantage
Workers Comp
O
205.90
39.63
47.86
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
EPO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
HMO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
Medicaid
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
Medicare Part A
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
Medicare Part B
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
POS
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
PPO
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
va
Workers Comp
O
205.90
39.63
49.29
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
EPO
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
HMO
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
Medicaid
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
Medicare Part A
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
Medicare Part B
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
POS
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
PPO
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93005
null
cpt
Routine electrocardiogram (EKG) with tracing using at least 12 leads
webtpa
Workers Comp
O
205.90
39.63
137.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
EPO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
HMO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
Medicaid
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
Medicare Part A
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
Medicare Part B
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
POS
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
PPO
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna
Workers Comp
O
447.42
84.79
259.50
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
EPO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
HMO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
Medicaid
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
Medicare Part A
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
Medicare Part B
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
POS
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
PPO
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
aetna - medicare advantage
Workers Comp
O
447.42
84.79
242.81
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
EPO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
HMO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
Medicaid
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
Medicare Part A
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
Medicare Part B
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
POS
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
PPO
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield
Workers Comp
O
447.42
84.79
84.86
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
EPO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
HMO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
Medicaid
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
Medicare Part A
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
Medicare Part B
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
POS
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
PPO
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
blue cross blue shield - medicare advantage
Workers Comp
O
447.42
84.79
84.79
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
EPO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
HMO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
Medicaid
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
Medicare Part A
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
Medicare Part B
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
POS
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
PPO
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
cigna
Workers Comp
O
447.42
84.79
316.61
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
humana - medicare advantage
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
EPO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
HMO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
Medicaid
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
Medicare Part A
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
Medicare Part B
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
POS
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
PPO
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
medica
Workers Comp
O
447.42
84.79
165.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
tricare
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
EPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
HMO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
Medicaid
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
Medicare Part A
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
Medicare Part B
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
POS
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
PPO
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
united healthcare - medicare advantage
Workers Comp
O
447.42
84.79
224.22
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
EPO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
HMO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
Medicaid
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
Medicare Part A
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
Medicare Part B
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
POS
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
PPO
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
va
Workers Comp
O
447.42
84.79
129.55
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
EPO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
HMO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
Medicaid
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
Medicare Part A
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
Medicare Part B
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
POS
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
PPO
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
webtpa
Workers Comp
O
447.42
84.79
298.28
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
EPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
HMO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
Medicaid
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
Medicare Part A
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
Medicare Part B
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
POS
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
PPO
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93017
null
cpt
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring
worker comp
Workers Comp
O
447.42
84.79
319.59
319.59
268.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
EPO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
HMO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
Medicaid
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
Medicare Part A
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
Medicare Part B
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
POS
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
PPO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
aetna
Workers Comp
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
EPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
HMO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
Medicaid
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
Medicare Part A
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
Medicare Part B
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
POS
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
PPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield
Workers Comp
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
EPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
HMO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
Medicaid
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
Medicare Part A
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
Medicare Part B
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
POS
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
PPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
blue cross blue shield - medicare advantage
Workers Comp
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
EPO
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
HMO
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
Medicaid
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
Medicare Part A
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
Medicare Part B
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
POS
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
PPO
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
humana - medicare advantage
Workers Comp
O
237.06
64.70
97.87
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
EPO
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
HMO
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
Medicaid
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
Medicare Part A
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
Medicare Part B
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
POS
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
PPO
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
tricare
Workers Comp
O
237.06
64.70
96.59
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
EPO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
HMO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
Medicaid
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
Medicare Part A
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
Medicare Part B
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
POS
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
PPO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
united healthcare
Workers Comp
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
EPO
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
HMO
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
Medicaid
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
Medicare Part A
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
Medicare Part B
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
POS
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
PPO
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93225
null
cpt
Heart rhythm tracing of 48-hour EKG
va
Workers Comp
O
237.06
64.70
99.14
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
EPO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
HMO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
Medicaid
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
Medicare Part A
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
Medicare Part B
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
POS
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
PPO
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna
Workers Comp
O
237.06
64.70
137.49
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
EPO
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
HMO
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
Medicaid
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
Medicare Part A
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
Medicare Part B
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
POS
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
PPO
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
aetna - medicare advantage
Workers Comp
O
237.06
64.70
99.15
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
EPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
HMO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
Medicaid
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
Medicare Part A
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
Medicare Part B
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
POS
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
PPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield
Workers Comp
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
EPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
HMO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
Medicaid
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
Medicare Part A
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
Medicare Part B
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
POS
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
PPO
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
blue cross blue shield - medicare advantage
Workers Comp
O
237.06
64.70
64.70
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
EPO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
HMO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
Medicaid
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
Medicare Part A
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
Medicare Part B
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
POS
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
PPO
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93226
null
cpt
Heart rhythm analysis interpretation and report of 48-hour EKG
united healthcare
Workers Comp
O
237.06
64.70
173.57
173.57
142.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
EPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
HMO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
Medicaid
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
Medicare Part A
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
Medicare Part B
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
POS
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
PPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield
Workers Comp
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
EPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
HMO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
Medicaid
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
Medicare Part A
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
Medicare Part B
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
POS
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
PPO
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
blue cross blue shield - medicare advantage
Workers Comp
O
162.49
31.63
86.27
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
EPO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
HMO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
Medicaid
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
Medicare Part A
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
Medicare Part B
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
POS
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
PPO
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
humana - medicare advantage
Workers Comp
O
162.49
31.63
31.63
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
EPO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
HMO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
Medicaid
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
Medicare Part A
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
Medicare Part B
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
POS
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
PPO
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
united healthcare
Workers Comp
O
162.49
31.63
116.07
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
EPO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
HMO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
Medicaid
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
Medicare Part A
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
Medicare Part B
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
POS
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
PPO
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93270
null
cpt
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days
webtpa
Workers Comp
O
162.49
31.63
108.33
116.07
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
EPO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
HMO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
Medicaid
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
Medicare Part A
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
Medicare Part B
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
POS
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
PPO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna
Workers Comp
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
EPO
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
HMO
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
Medicaid
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
Medicare Part A
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
Medicare Part B
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
POS
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
PPO
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
aetna - medicare advantage
Workers Comp
O
180.49
32.11
32.11
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
EPO
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
HMO
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
Medicaid
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part A
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part B
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
POS
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
PPO
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
blue cross blue shield
Workers Comp
O
180.49
32.11
76.59
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
EPO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
HMO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
Medicaid
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
Medicare Part A
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
Medicare Part B
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
POS
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
PPO
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93279
null
cpt
Evaluation testing and programming adjustment of permanent single lead pacemaker system in one chamber of heart with qualified health care professional analysis review and report
humana - medicare advantage
Workers Comp
O
180.49
32.11
32.90
76.59
108.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
EPO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
HMO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
Medicaid
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
Medicare Part A
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
Medicare Part B
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
POS
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
PPO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
aetna
Workers Comp
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
EPO
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
HMO
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
Medicaid
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
Medicare Part A
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
Medicare Part B
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
POS
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
PPO
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield
Workers Comp
O
214.80
32.08
76.59
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
EPO
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
HMO
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
Medicaid
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
Medicare Part A
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
Medicare Part B
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
POS
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
PPO
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
blue cross blue shield - medicare advantage
Workers Comp
O
214.80
32.08
32.43
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
EPO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
HMO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicaid
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicare Part A
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicare Part B
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
POS
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
PPO
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
humana - medicare advantage
Workers Comp
O
214.80
32.08
32.11
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
EPO
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
HMO
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
Medicaid
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
Medicare Part A
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
Medicare Part B
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
POS
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
PPO
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93280
null
cpt
Evaluation testing and programming adjustment of permanent dual lead pacemaker system with physician analysis review and report
tricare
Workers Comp
O
214.80
32.08
32.08
76.59
128.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
EPO
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
HMO
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicaid
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicare Part A
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
Medicare Part B
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
POS
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
PPO
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93281
null
cpt
Evaluation testing and programming adjustment of permanent multiple lead pacemaker system with physician analysis review and report
humana - medicare advantage
Workers Comp
O
229.27
32.90
32.90
32.90
137.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
EPO
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
HMO
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
Medicaid
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
Medicare Part A
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
Medicare Part B
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
POS
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
PPO
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
blue cross blue shield
Workers Comp
O
208.13
32.11
77.03
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
EPO
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
HMO
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
Medicaid
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
Medicare Part A
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
Medicare Part B
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
POS
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
PPO
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
humana - medicare advantage
Workers Comp
O
208.13
32.11
32.11
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
EPO
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
HMO
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
Medicaid
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
Medicare Part A
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
Medicare Part B
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
POS
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
PPO
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93282
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report single lead defibrillator system
va
Workers Comp
O
208.13
32.11
32.90
77.03
124.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
EPO
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
HMO
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
Medicaid
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
Medicare Part A
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
Medicare Part B
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
POS
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
PPO
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
blue cross blue shield
Workers Comp
O
257.10
32.90
76.59
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
EPO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
HMO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
Medicaid
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
Medicare Part A
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
Medicare Part B
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
POS
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
PPO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
humana - medicare advantage
Workers Comp
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
EPO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
HMO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
Medicaid
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
Medicare Part A
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
Medicare Part B
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
POS
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
PPO
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93283
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report dual lead defibrillator system
va
Workers Comp
O
257.10
32.90
32.90
76.59
154.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
EPO
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
HMO
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
Medicaid
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
Medicare Part A
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
Medicare Part B
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
POS
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
PPO
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
blue cross blue shield
Workers Comp
O
301.62
32.11
53.84
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
EPO
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
HMO
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
Medicaid
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
Medicare Part A
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
Medicare Part B
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
POS
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
PPO
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
humana - medicare advantage
Workers Comp
O
301.62
32.11
32.11
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
EPO
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
HMO
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
Medicaid
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
Medicare Part A
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
Medicare Part B
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
POS
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
PPO
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93284
null
cpt
Evaluation testing and programming adjustment of defibrillator with analysis review and report multiple lead defibrillator system
va
Workers Comp
O
301.62
32.11
32.90
53.84
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
EPO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
HMO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
Medicaid
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
Medicare Part A
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
Medicare Part B
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
POS
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
PPO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
aetna - medicare advantage
Workers Comp
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
EPO
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
HMO
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
Medicaid
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part A
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part B
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
POS
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
PPO
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield
Workers Comp
O
301.62
31.47
76.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
EPO
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
HMO
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
Medicaid
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
Medicare Part A
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
Medicare Part B
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
POS
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
PPO
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
blue cross blue shield - medicare advantage
Workers Comp
O
301.62
31.47
71.59
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
EPO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
HMO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
Medicaid
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
Medicare Part A
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
Medicare Part B
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
POS
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
PPO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
humana - medicare advantage
Workers Comp
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
EPO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
HMO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
Medicaid
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
Medicare Part A
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
Medicare Part B
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
POS
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
PPO
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
tricare
Workers Comp
O
301.62
31.47
32.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
EPO
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
HMO
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
Medicaid
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
Medicare Part A
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
Medicare Part B
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
POS
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
PPO
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare
Workers Comp
O
301.62
31.47
215.45
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
EPO
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
HMO
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
Medicaid
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
Medicare Part A
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
Medicare Part B
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
POS
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
PPO
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
united healthcare - medicare advantage
Workers Comp
O
301.62
31.47
31.47
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
EPO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
HMO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
Medicaid
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
Medicare Part A
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
Medicare Part B
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
POS
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
PPO
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
va
Workers Comp
O
301.62
31.47
32.90
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
EPO
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
HMO
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
Medicaid
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
Medicare Part A
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
Medicare Part B
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
POS
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
PPO
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93288
null
cpt
Evaluation of parameters of leadless single dual or multiple lead pacemaker system with qualified health care professional analysis review and report
webtpa
Workers Comp
O
301.62
31.47
206.11
215.45
180.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
EPO
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
HMO
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
Medicaid
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
Medicare Part A
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
Medicare Part B
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
POS
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
PPO
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
aetna
Workers Comp
O
194.77
32.05
112.97
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
EPO
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
HMO
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
Medicaid
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
Medicare Part A
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
Medicare Part B
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
POS
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
PPO
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield
Workers Comp
O
194.77
32.05
76.59
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
EPO
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
HMO
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
Medicaid
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
Medicare Part A
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
Medicare Part B
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
POS
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
PPO
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
blue cross blue shield - medicare advantage
Workers Comp
O
194.77
32.05
65.22
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
EPO
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
HMO
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
Medicaid
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
Medicare Part A
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
Medicare Part B
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
POS
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
PPO
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
humana - medicare advantage
Workers Comp
O
194.77
32.05
32.11
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
EPO
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
HMO
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
Medicaid
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
Medicare Part A
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
Medicare Part B
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
POS
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
PPO
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
tricare
Workers Comp
O
194.77
32.05
32.05
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
EPO
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
HMO
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
Medicaid
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
Medicare Part A
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
Medicare Part B
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
POS
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
PPO
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93289
null
cpt
Evaluation of defibrillator including connection recording and disconnection
va
Workers Comp
O
194.77
32.05
32.90
112.97
116.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
EPO
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
HMO
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
Medicaid
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part A
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part B
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
POS
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
PPO
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93290
null
cpt
Evaluation of parameters of implantable heart and blood vessel monitor system with qualified health care professional analysis review and report
blue cross blue shield
Workers Comp
O
100.27
35.20
35.20
35.20
60.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
EPO
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
HMO
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
Medicaid
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part A
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
Medicare Part B
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
POS
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
PPO
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
blue cross blue shield
Workers Comp
O
117.34
20.37
71.59
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
EPO
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
HMO
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
Medicaid
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
Medicare Part A
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
Medicare Part B
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
POS
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
PPO
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
tricare
Workers Comp
O
117.34
20.37
20.37
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
EPO
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
HMO
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
Medicaid
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
Medicare Part A
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
Medicare Part B
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
POS
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
PPO
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93291
null
cpt
Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis review and report
va
Workers Comp
O
117.34
20.37
40.52
71.59
70.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
EPO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
HMO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
Medicaid
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
Medicare Part A
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
Medicare Part B
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
POS
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
PPO
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna
Workers Comp
O
1777.46
426.62
1030.93
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
aetna - medicare advantage
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
EPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
HMO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
Medicaid
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
Medicare Part A
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
Medicare Part B
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
POS
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
PPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield
Workers Comp
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
EPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
HMO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
Medicaid
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
Medicare Part A
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
Medicare Part B
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
POS
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
PPO
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
blue cross blue shield - medicare advantage
Workers Comp
O
1777.46
426.62
514.25
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
EPO
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
HMO
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
Medicaid
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
Medicare Part A
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
Medicare Part B
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
POS
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
PPO
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
cigna
Workers Comp
O
1777.46
426.62
1257.77
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
geha
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
EPO
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
HMO
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
Medicaid
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
Medicare Part A
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
Medicare Part B
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
POS
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
PPO
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
humana - medicare advantage
Workers Comp
O
1777.46
426.62
427.67
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
tricare
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
EPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
HMO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
Medicaid
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
Medicare Part A
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
Medicare Part B
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
POS
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
PPO
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
united healthcare - medicare advantage
Workers Comp
O
1777.46
426.62
426.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
EPO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
HMO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
Medicaid
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
Medicare Part A
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
Medicare Part B
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
POS
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
PPO
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
va
Workers Comp
O
1777.46
426.62
427.65
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
EPO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
HMO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
Medicaid
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
Medicare Part A
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
Medicare Part B
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
POS
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
PPO
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
webtpa
Workers Comp
O
1777.46
426.62
1184.97
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
EPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
HMO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
Medicaid
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
Medicare Part A
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
Medicare Part B
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
POS
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
PPO
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93306
null
cpt
Ultrasound examination of heart including color-depicted blood flow rate direction and valve function
worker comp
Workers Comp
O
1777.46
426.62
1269.62
1269.62
1066.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
EPO
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
HMO
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
Medicaid
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
Medicare Part A
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
Medicare Part B
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
POS
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
PPO
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
aetna
Workers Comp
O
391.77
203.81
220.14
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
EPO
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
HMO
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
Medicaid
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
Medicare Part A
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
Medicare Part B
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
POS
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
PPO
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield
Workers Comp
O
391.77
203.81
382.45
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
EPO
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
HMO
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
Medicaid
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
Medicare Part A
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
Medicare Part B
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
POS
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
PPO
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
blue cross blue shield - medicare advantage
Workers Comp
O
391.77
203.81
391.77
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
EPO
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
HMO
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
Medicaid
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
Medicare Part A
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
Medicare Part B
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
POS
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
PPO
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
humana - medicare advantage
Workers Comp
O
391.77
203.81
203.81
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
EPO
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
HMO
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
Medicaid
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
Medicare Part A
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
Medicare Part B
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
POS
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
PPO
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
tricare
Workers Comp
O
391.77
203.81
205.13
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
EPO
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
HMO
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
Medicaid
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
Medicare Part A
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
Medicare Part B
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
POS
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
PPO
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
united healthcare
Workers Comp
O
391.77
203.81
279.84
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
EPO
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
HMO
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
Medicaid
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
Medicare Part A
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
Medicare Part B
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
POS
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
PPO
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93308
null
cpt
Follow-up or limited ultrasound examination of heart
webtpa
Workers Comp
O
391.77
203.81
261.18
391.77
235.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
EPO
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
HMO
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
Medicaid
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
Medicare Part A
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
Medicare Part B
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
POS
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
PPO
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield
Workers Comp
O
1653.91
375.09
375.14
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
EPO
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
HMO
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
Medicaid
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part A
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
Medicare Part B
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
POS
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
PPO
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
blue cross blue shield - medicare advantage
Workers Comp
O
1653.91
375.09
375.09
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
EPO
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
HMO
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
Medicaid
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
Medicare Part A
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
Medicare Part B
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
POS
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
PPO
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
humana - medicare advantage
Workers Comp
O
1653.91
375.09
426.62
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
EPO
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
HMO
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
Medicaid
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
Medicare Part A
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
Medicare Part B
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
POS
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
PPO
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
tricare
Workers Comp
O
1653.91
375.09
427.67
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
EPO
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
HMO
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
Medicaid
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
Medicare Part A
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
Medicare Part B
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
POS
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
PPO
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93312
null
cpt
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report
va
Workers Comp
O
1653.91
375.09
427.65
427.67
992.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
EPO
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
HMO
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
Medicaid
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
Medicare Part A
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
Medicare Part B
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
POS
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
PPO
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
aetna
Workers Comp
O
1276.61
426.62
740.43
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
EPO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
HMO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
Medicaid
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
Medicare Part A
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
Medicare Part B
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
POS
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
PPO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield
Workers Comp
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
EPO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
HMO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
Medicaid
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
Medicare Part A
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
Medicare Part B
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
POS
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
PPO
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
blue cross blue shield - medicare advantage
Workers Comp
O
1276.61
426.62
514.25
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
EPO
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
HMO
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
Medicaid
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
Medicare Part A
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
Medicare Part B
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
POS
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
PPO
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
cigna
Workers Comp
O
1276.61
426.62
852.29
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
EPO
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
HMO
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
Medicaid
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
Medicare Part A
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
Medicare Part B
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
POS
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
PPO
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
humana - medicare advantage
Workers Comp
O
1276.61
426.62
427.67
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
EPO
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
HMO
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
Medicaid
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
Medicare Part A
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
Medicare Part B
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
POS
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
PPO
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
tricare
Workers Comp
O
1276.61
426.62
426.62
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
EPO
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
HMO
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
Medicaid
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
Medicare Part A
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
Medicare Part B
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
POS
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
PPO
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
united healthcare
Workers Comp
O
1276.61
426.62
911.87
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
EPO
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
HMO
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
Medicaid
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
Medicare Part A
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
Medicare Part B
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
POS
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
PPO
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
va
Workers Comp
O
1276.61
426.62
427.65
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
EPO
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
HMO
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
Medicaid
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
Medicare Part A
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
Medicare Part B
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
POS
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
PPO
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93350
null
cpt
Ultrasound examination of the heart performed during rest exercise and/or drug-induced stress with interpretation and report
webtpa
Workers Comp
O
1276.61
426.62
851.07
911.87
765.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
EPO
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
HMO
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
Medicaid
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
Medicare Part A
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
Medicare Part B
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
POS
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
PPO
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93451
null
cpt
Insertion of catheter for diagnostic evaluation of right heart structures
humana - medicare advantage
Workers Comp
O
13781.91
2517.49
2517.49
2517.49
8269.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
EPO
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
HMO
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
Medicaid
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
Medicare Part A
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
Medicare Part B
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
POS
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
PPO
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93452
null
cpt
Diagnostic heart catheter left
aetna
Workers Comp
I
54103.79
7333.25
7333.25
7333.25
32462.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
EPO
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
HMO
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
Medicaid
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
Medicare Part A
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
Medicare Part B
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
POS
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
PPO
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93453
null
cpt
Insertion of catheter into right and left heart for diagnosis
humana - medicare advantage
Workers Comp
O
14321.38
2524.71
2524.71
2524.71
8592.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
EPO
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
HMO
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicaid
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part A
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part B
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
POS
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
PPO
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93454
null
cpt
Insertion of catheter for imaging of heart including imaging interpretation and supervision and injection
blue cross blue shield
Workers Comp
O
28879.86
24853.04
24853.04
24853.04
17327.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
EPO
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
HMO
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
Medicaid
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part A
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part B
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
POS
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
PPO
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93455
null
cpt
Insertion of catheter for imaging of heart blood vessels and/or grafts including imaging interpretation and supervision and injection
blue cross blue shield
Workers Comp
O
13834.73
2417.02
2417.02
2417.02
8300.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
EPO
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
HMO
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
Medicaid
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
Medicare Part A
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
Medicare Part B
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
POS
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
PPO
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
aetna
Workers Comp
O
23979.13
2418.76
5709.57
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
EPO
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
HMO
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicaid
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part A
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part B
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
POS
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
PPO
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Workers Comp
O
23979.13
2418.76
2418.76
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
EPO
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
HMO
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicaid
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part A
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part B
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
POS
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
PPO
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Workers Comp
O
23979.13
2418.76
2451.03
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
EPO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
HMO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicaid
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part A
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part B
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
POS
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
PPO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Workers Comp
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
EPO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
HMO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
Medicaid
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part A
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part B
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
POS
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
PPO
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
tricare
Workers Comp
O
23979.13
2418.76
2567.49
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
EPO
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
HMO
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
Medicaid
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
Medicare Part A
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
Medicare Part B
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
POS
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
PPO
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare
Workers Comp
O
23979.13
2418.76
16100.16
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
EPO
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
HMO
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
Medicaid
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
Medicare Part A
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
Medicare Part B
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
POS
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
PPO
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
united healthcare - medicare advantage
Workers Comp
O
23979.13
2418.76
2524.71
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
EPO
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
HMO
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
Medicaid
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part A
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part B
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
POS
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
PPO
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93458
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection
va
Workers Comp
O
23979.13
2418.76
2567.40
16100.16
14387.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
EPO
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
HMO
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
Medicaid
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
Medicare Part A
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
Medicare Part B
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
POS
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
PPO
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
aetna
Workers Comp
O
27593.76
2416.95
4307.30
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
EPO
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
HMO
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicaid
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part A
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part B
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
POS
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
PPO
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Workers Comp
O
27593.76
2416.95
2421.92
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
EPO
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
HMO
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicaid
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part A
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part B
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
POS
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
PPO
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Workers Comp
O
27593.76
2416.95
2416.95
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
EPO
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
HMO
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicaid
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part A
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part B
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
POS
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
PPO
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Workers Comp
O
27593.76
2416.95
8777.72
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
EPO
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
HMO
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
Medicaid
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part A
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part B
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
POS
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
PPO
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
tricare
Workers Comp
O
27593.76
2416.95
2524.71
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
EPO
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
HMO
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
Medicaid
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part A
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part B
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
POS
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
PPO
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93459
null
cpt
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection
va
Workers Comp
O
27593.76
2416.95
5655.03
8777.72
16556.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
EPO
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
HMO
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
Medicaid
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
Medicare Part A
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
Medicare Part B
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
POS
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
PPO
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
aetna - medicare advantage
Workers Comp
O
17442.90
2405.95
2546.10
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
EPO
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
HMO
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicaid
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part A
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Medicare Part B
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
POS
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
PPO
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield
Workers Comp
O
17442.90
2405.95
2443.24
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
EPO
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
HMO
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicaid
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part A
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Medicare Part B
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
POS
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
PPO
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
blue cross blue shield - medicare advantage
Workers Comp
O
17442.90
2405.95
2405.95
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
EPO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
HMO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicaid
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part A
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part B
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
POS
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
PPO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
humana - medicare advantage
Workers Comp
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
EPO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
HMO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
Medicaid
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part A
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
Medicare Part B
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
POS
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
PPO
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
tricare
Workers Comp
O
17442.90
2405.95
2524.71
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
EPO
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
HMO
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
Medicaid
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part A
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
Medicare Part B
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
POS
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
PPO
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93460
null
cpt
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection
va
Workers Comp
O
17442.90
2405.95
2567.40
2567.40
10465.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
EPO
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
HMO
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
Medicaid
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part A
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
Medicare Part B
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
POS
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
PPO
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93461
null
cpt
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection
humana - medicare advantage
Workers Comp
O
20220.65
2524.71
2524.71
2524.71
12132.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
EPO
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
HMO
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
Medicaid
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
Medicare Part A
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
Medicare Part B
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
POS
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
PPO
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
blue cross blue shield
Workers Comp
O
18777.52
2418.76
2418.76
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
EPO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
HMO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
Medicaid
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
Medicare Part A
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
Medicare Part B
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
POS
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
PPO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
humana - medicare advantage
Workers Comp
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
EPO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
HMO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
Medicaid
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
Medicare Part A
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
Medicare Part B
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
POS
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
PPO
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93567
null
cpt
Injection for X-ray imaging of aorta above heart valve
tricare
Workers Comp
O
18777.52
2418.76
2524.71
2524.71
11266.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
EPO
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
HMO
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
Medicaid
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
Medicare Part A
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
Medicare Part B
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
POS
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
PPO
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
aetna
Workers Comp
O
31869.06
4389.98
9249.37
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
EPO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
HMO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicaid
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicare Part A
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Medicare Part B
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
POS
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
PPO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
humana - medicare advantage
Workers Comp
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
EPO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
HMO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
Medicaid
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
Medicare Part A
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
Medicare Part B
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
POS
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
PPO
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
tricare
Workers Comp
O
31869.06
4389.98
4389.98
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
EPO
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
HMO
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
Medicaid
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
Medicare Part A
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
Medicare Part B
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
POS
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
PPO
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93571
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment initial vessel
va
Workers Comp
O
31869.06
4389.98
8907.52
9249.37
19121.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
EPO
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
HMO
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
Medicaid
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
Medicare Part A
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
Medicare Part B
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
POS
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
PPO
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93572
null
cpt
Ultrasound evaluation of heart blood vessel during diagnosis or treatment each additional vessel
tricare
Workers Comp
O
32696.90
4389.98
4389.98
4389.98
19618.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
EPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
HMO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
Medicaid
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
Medicare Part A
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
Medicare Part B
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
POS
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
PPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
aetna
Workers Comp
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
EPO
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
HMO
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
Medicaid
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
Medicare Part A
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
Medicare Part B
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
POS
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
PPO
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield
Workers Comp
O
1075.15
157.92
278.59
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
EPO
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
HMO
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
Medicaid
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
Medicare Part A
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
Medicare Part B
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
POS
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
PPO
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
blue cross blue shield - medicare advantage
Workers Comp
O
1075.15
157.92
157.92
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
EPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
HMO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
Medicaid
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
Medicare Part A
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
Medicare Part B
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
POS
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
PPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
humana - medicare advantage
Workers Comp
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
EPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
HMO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
Medicaid
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
Medicare Part A
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
Medicare Part B
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
POS
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
PPO
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93660
null
cpt
Evaluation of heart function using tilt table
tricare
Workers Comp
O
1075.15
157.92
430.19
430.19
645.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
EPO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
HMO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
Medicaid
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
Medicare Part A
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
Medicare Part B
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
POS
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
PPO
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
blue cross blue shield
Workers Comp
O
132.44
49.29
73.57
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
EPO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
HMO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
Medicaid
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
Medicare Part A
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
Medicare Part B
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
POS
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
PPO
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93668
null
cpt
Peripheral arterial disease (PAD) rehabilitation per session
humana - medicare advantage
Workers Comp
O
132.44
49.29
49.29
73.57
79.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
EPO
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
HMO
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
Medicaid
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
Medicare Part A
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
Medicare Part B
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
POS
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
PPO
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna
Workers Comp
O
164.05
92.18
92.18
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
EPO
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
HMO
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
Medicaid
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
Medicare Part A
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
Medicare Part B
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
POS
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
PPO
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
aetna - medicare advantage
Workers Comp
O
164.05
92.18
102.79
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
EPO
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
HMO
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
Medicaid
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
Medicare Part A
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
Medicare Part B
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
POS
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
PPO
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield
Workers Comp
O
164.05
92.18
123.04
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
EPO
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
HMO
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
Medicaid
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
Medicare Part A
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
Medicare Part B
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
POS
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
PPO
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
blue cross blue shield - medicare advantage
Workers Comp
O
164.05
92.18
106.19
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
EPO
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
HMO
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
Medicaid
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
Medicare Part A
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
Medicare Part B
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
POS
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
PPO
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
cigna
Workers Comp
O
164.05
92.18
116.09
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
EPO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
HMO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
Medicaid
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
Medicare Part A
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
Medicare Part B
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
POS
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
PPO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
humana - medicare advantage
Workers Comp
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
EPO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
HMO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
Medicaid
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
Medicare Part A
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
Medicare Part B
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
POS
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
PPO
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
tricare
Workers Comp
O
164.05
92.18
97.47
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
EPO
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
HMO
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
Medicaid
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
Medicare Part A
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
Medicare Part B
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
POS
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
PPO
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93798
null
cpt
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session
va
Workers Comp
O
164.05
92.18
102.78
123.04
116.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
EPO
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
HMO
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
Medicaid
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
Medicare Part A
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
Medicare Part B
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
POS
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
PPO
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna
Workers Comp
O
671.13
203.81
383.19
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
aetna - medicare advantage
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
EPO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
HMO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
Medicaid
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
Medicare Part A
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
Medicare Part B
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
POS
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
PPO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield
Workers Comp
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
EPO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
HMO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
Medicaid
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
Medicare Part A
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
Medicare Part B
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
POS
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
PPO
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
blue cross blue shield - medicare advantage
Workers Comp
O
671.13
203.81
216.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
EPO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
HMO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
Medicaid
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
Medicare Part A
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
Medicare Part B
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
POS
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
PPO
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
healthchoice
Workers Comp
O
671.13
203.81
213.86
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
humana - medicare advantage
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
EPO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
HMO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
Medicaid
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
Medicare Part A
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
Medicare Part B
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
POS
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
PPO
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
medica
Workers Comp
O
671.13
203.81
248.32
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
EPO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
HMO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
Medicaid
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
Medicare Part A
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
Medicare Part B
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
POS
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
PPO
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
tricare
Workers Comp
O
671.13
203.81
206.45
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
EPO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
HMO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
Medicaid
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
Medicare Part A
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
Medicare Part B
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
POS
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
PPO
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare
Workers Comp
O
671.13
203.81
479.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
EPO
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
HMO
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
Medicaid
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
Medicare Part A
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
Medicare Part B
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
POS
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
PPO
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
united healthcare - medicare advantage
Workers Comp
O
671.13
203.81
204.39
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
EPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
HMO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
Medicaid
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
Medicare Part A
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
Medicare Part B
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
POS
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
PPO
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
va
Workers Comp
O
671.13
203.81
203.81
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
EPO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
HMO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
Medicaid
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
Medicare Part A
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
Medicare Part B
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
POS
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
PPO
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93880
null
cpt
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck
webtpa
Workers Comp
O
671.13
203.81
469.79
479.39
402.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
EPO
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
HMO
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
Medicaid
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
Medicare Part A
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
Medicare Part B
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
POS
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
PPO
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93882
null
cpt
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited
webtpa
Workers Comp
O
321.71
365.06
365.06
365.06
193.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
EPO
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
HMO
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
Medicaid
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
Medicare Part A
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
Medicare Part B
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
POS
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
PPO
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
blue cross blue shield
Workers Comp
O
367.29
96.59
286.66
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
EPO
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
HMO
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
Medicaid
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
Medicare Part A
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
Medicare Part B
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
POS
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
PPO
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
humana - medicare advantage
Workers Comp
O
367.29
96.59
99.15
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
EPO
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
HMO
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
Medicaid
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
Medicare Part A
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
Medicare Part B
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
POS
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
PPO
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
tricare
Workers Comp
O
367.29
96.59
96.59
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
EPO
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
HMO
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
Medicaid
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
Medicare Part A
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
Medicare Part B
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
POS
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
PPO
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93922
null
cpt
Ultrasound study of arteries of both arms and legs limited
va
Workers Comp
O
367.29
96.59
96.62
286.66
220.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
EPO
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
HMO
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
Medicaid
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
Medicare Part A
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
Medicare Part B
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
POS
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
PPO
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93923
null
cpt
Ultrasound study of arteries of both arms and legs complete
humana - medicare advantage
Workers Comp
O
419.99
123.59
123.59
123.59
251.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
EPO
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
HMO
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
Medicaid
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
Medicare Part A
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
Medicare Part B
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
POS
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
PPO
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
cigna
Workers Comp
O
403.86
120.11
283.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
EPO
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
HMO
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
Medicaid
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
Medicare Part A
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
Medicare Part B
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
POS
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
PPO
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
humana - medicare advantage
Workers Comp
O
403.86
120.11
120.11
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
EPO
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
HMO
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
Medicaid
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
Medicare Part A
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
Medicare Part B
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
POS
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
PPO
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93924
null
cpt
Ultrasound study of arteries of both legs at rest and exercise
tricare
Workers Comp
O
403.86
120.11
234.21
283.11
242.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
EPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
HMO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
Medicaid
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
Medicare Part A
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
Medicare Part B
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
POS
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
PPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna
Workers Comp
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
EPO
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
HMO
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
Medicaid
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
Medicare Part A
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
Medicare Part B
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
POS
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
PPO
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
aetna - medicare advantage
Workers Comp
O
685.60
203.81
205.13
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
EPO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
HMO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
Medicaid
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
Medicare Part A
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
Medicare Part B
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
POS
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
PPO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield
Workers Comp
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
EPO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
HMO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
Medicaid
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
Medicare Part A
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
Medicare Part B
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
POS
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
PPO
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
blue cross blue shield - medicare advantage
Workers Comp
O
685.60
203.81
359.62
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
EPO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
HMO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
Medicaid
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
Medicare Part A
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
Medicare Part B
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
POS
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
PPO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
humana - medicare advantage
Workers Comp
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
EPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
HMO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
Medicaid
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
Medicare Part A
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
Medicare Part B
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
POS
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
PPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
tricare
Workers Comp
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
EPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
HMO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
Medicaid
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
Medicare Part A
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
Medicare Part B
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
POS
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
PPO
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
united healthcare - medicare advantage
Workers Comp
O
685.60
203.81
206.45
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
EPO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
HMO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
Medicaid
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
Medicare Part A
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
Medicare Part B
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
POS
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
PPO
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
va
Workers Comp
O
685.60
203.81
203.81
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
EPO
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
HMO
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
Medicaid
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
Medicare Part A
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
Medicare Part B
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
POS
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
PPO
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93925
null
cpt
Ultrasound study of arteries and arterial grafts of both legs
webtpa
Workers Comp
O
685.60
203.81
457.07
457.07
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
EPO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
HMO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
Medicaid
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
Medicare Part A
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
Medicare Part B
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
POS
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
PPO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
aetna
Workers Comp
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
EPO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
HMO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
Medicaid
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
Medicare Part A
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
Medicare Part B
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
POS
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
PPO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield
Workers Comp
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
EPO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
HMO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
Medicaid
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
Medicare Part A
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
Medicare Part B
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
POS
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
PPO
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
blue cross blue shield - medicare advantage
Workers Comp
O
575.42
96.50
359.62
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
EPO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
HMO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
Medicaid
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
Medicare Part A
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
Medicare Part B
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
POS
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
PPO
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
humana - medicare advantage
Workers Comp
O
575.42
96.50
99.29
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
EPO
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
HMO
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
Medicaid
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
Medicare Part A
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
Medicare Part B
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
POS
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
PPO
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
tricare
Workers Comp
O
575.42
96.50
98.16
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
EPO
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
HMO
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
Medicaid
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
Medicare Part A
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
Medicare Part B
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
POS
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
PPO
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
united healthcare
Workers Comp
O
575.42
96.50
411.02
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
EPO
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
HMO
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
Medicaid
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
Medicare Part A
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
Medicare Part B
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
POS
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
PPO
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93926
null
cpt
Ultrasound study of arteries and arterial grafts of one leg or limited
va
Workers Comp
O
575.42
96.50
96.50
411.02
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
EPO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
HMO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
Medicaid
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
Medicare Part A
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
Medicare Part B
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
POS
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
PPO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield
Workers Comp
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
EPO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
HMO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
Medicaid
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
Medicare Part A
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
Medicare Part B
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
POS
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
PPO
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
blue cross blue shield - medicare advantage
Workers Comp
O
685.60
203.81
216.32
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
EPO
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
HMO
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
Medicaid
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
Medicare Part A
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
Medicare Part B
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
POS
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
PPO
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
humana - medicare advantage
Workers Comp
O
685.60
203.81
205.13
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
EPO
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
HMO
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
Medicaid
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
Medicare Part A
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
Medicare Part B
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
POS
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
PPO
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93930
null
cpt
Ultrasound study of arteries and arterial grafts of both arms
tricare
Workers Comp
O
685.60
203.81
203.81
216.32
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
EPO
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
HMO
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
Medicaid
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
Medicare Part A
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
Medicare Part B
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
POS
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
PPO
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
blue cross blue shield
Workers Comp
O
575.42
76.07
76.07
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
EPO
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
HMO
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
Medicaid
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
Medicare Part A
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
Medicare Part B
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
POS
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
PPO
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
geha
Workers Comp
O
575.42
76.07
411.02
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
EPO
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
HMO
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
Medicaid
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
Medicare Part A
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
Medicare Part B
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
POS
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
PPO
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
humana - medicare advantage
Workers Comp
O
575.42
76.07
96.51
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
EPO
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
HMO
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
Medicaid
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
Medicare Part A
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
Medicare Part B
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
POS
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
PPO
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
tricare
Workers Comp
O
575.42
76.07
99.29
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
EPO
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
HMO
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
Medicaid
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
Medicare Part A
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
Medicare Part B
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
POS
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
PPO
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
united healthcare
Workers Comp
O
575.42
76.07
431.57
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
EPO
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
HMO
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
Medicaid
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
Medicare Part A
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
Medicare Part B
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
POS
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
PPO
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
va
Workers Comp
O
575.42
76.07
96.50
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
EPO
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
HMO
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
Medicaid
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
Medicare Part A
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
Medicare Part B
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
POS
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
PPO
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93931
null
cpt
Ultrasound study of arteries and arterial grafts of one arm or limited
webtpa
Workers Comp
O
575.42
76.07
383.61
431.57
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
EPO
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
HMO
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
Medicaid
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
Medicare Part A
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
Medicare Part B
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
POS
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
PPO
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna
Workers Comp
O
988.34
195.05
579.75
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
EPO
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
HMO
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicaid
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicare Part A
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicare Part B
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
POS
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
PPO
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
aetna - medicare advantage
Workers Comp
O
988.34
195.05
195.05
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
EPO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
HMO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
Medicaid
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
Medicare Part A
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
Medicare Part B
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
POS
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
PPO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield
Workers Comp
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
EPO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
HMO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicaid
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicare Part A
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicare Part B
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
POS
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
PPO
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Workers Comp
O
988.34
195.05
359.62
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
EPO
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
HMO
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
Medicaid
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
Medicare Part A
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
Medicare Part B
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
POS
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
PPO
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
humana - medicare advantage
Workers Comp
O
988.34
195.05
203.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
EPO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
HMO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
Medicaid
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
Medicare Part A
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
Medicare Part B
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
POS
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
PPO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
tricare
Workers Comp
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
EPO
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
HMO
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
Medicaid
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
Medicare Part A
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
Medicare Part B
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
POS
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
PPO
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare
Workers Comp
O
988.34
195.05
773.81
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
EPO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
HMO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicaid
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicare Part A
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicare Part B
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
POS
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
PPO
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Workers Comp
O
988.34
195.05
206.45
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
EPO
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
HMO
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
Medicaid
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
Medicare Part A
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
Medicare Part B
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
POS
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
PPO
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
va
Workers Comp
O
988.34
195.05
334.20
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
EPO
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
HMO
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
Medicaid
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
Medicare Part A
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
Medicare Part B
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
POS
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
PPO
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93970
null
cpt
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers
webtpa
Workers Comp
O
988.34
195.05
687.83
773.81
593.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
EPO
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
HMO
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
Medicaid
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
Medicare Part A
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
Medicare Part B
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
POS
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
PPO
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna
Workers Comp
O
685.60
96.50
401.77
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
EPO
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
HMO
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicaid
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicare Part A
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
Medicare Part B
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
POS
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
PPO
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
aetna - medicare advantage
Workers Comp
O
685.60
96.50
98.35
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
EPO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
HMO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
Medicaid
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
Medicare Part A
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
Medicare Part B
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
POS
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
PPO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield
Workers Comp
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
EPO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
HMO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicaid
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicare Part A
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Medicare Part B
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
POS
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
PPO
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
blue cross blue shield - medicare advantage
Workers Comp
O
685.60
96.50
359.62
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
EPO
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
HMO
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
Medicaid
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
Medicare Part A
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
Medicare Part B
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
POS
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
PPO
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
humana - medicare advantage
Workers Comp
O
685.60
96.50
96.51
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
EPO
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
HMO
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
Medicaid
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
Medicare Part A
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
Medicare Part B
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
POS
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
PPO
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
tricare
Workers Comp
O
685.60
96.50
99.29
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
EPO
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
HMO
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
Medicaid
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
Medicare Part A
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
Medicare Part B
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
POS
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
PPO
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare
Workers Comp
O
685.60
96.50
515.96
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
EPO
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
HMO
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicaid
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicare Part A
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Medicare Part B
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
POS
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
PPO
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
united healthcare - medicare advantage
Workers Comp
O
685.60
96.50
97.31
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
EPO
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
HMO
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
Medicaid
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
Medicare Part A
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
Medicare Part B
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
POS
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
PPO
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
va
Workers Comp
O
685.60
96.50
96.50
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
EPO
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
HMO
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
Medicaid
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
Medicare Part A
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
Medicare Part B
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
POS
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
PPO
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
93971
null
cpt
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
webtpa
Workers Comp
O
685.60
96.50
479.92
515.96
411.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
EPO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
HMO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
Medicaid
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
Medicare Part A
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
Medicare Part B
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
POS
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
PPO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield
Workers Comp
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
EPO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
HMO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
Medicaid
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
Medicare Part A
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
Medicare Part B
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
POS
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
PPO
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
blue cross blue shield - medicare advantage
Workers Comp
O
198.11
50.61
50.61
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
EPO
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
HMO
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
Medicaid
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
Medicare Part A
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
Medicare Part B
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
POS
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
PPO
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
cigna
Workers Comp
O
198.11
50.61
132.27
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
EPO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
HMO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
Medicaid
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
Medicare Part A
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
Medicare Part B
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
POS
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
PPO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
humana - medicare advantage
Workers Comp
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
EPO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
HMO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
Medicaid
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
Medicare Part A
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
Medicare Part B
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
POS
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
PPO
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94010
null
cpt
Measurement and graphic recording of total and timed exhaled air capacity
tricare
Workers Comp
O
198.11
50.61
123.59
132.27
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
EPO
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
HMO
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
Medicaid
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
Medicare Part A
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
Medicare Part B
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
POS
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
PPO
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna
Workers Comp
O
358.28
76.78
214.79
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
EPO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
HMO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
Medicaid
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
Medicare Part A
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
Medicare Part B
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
POS
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
PPO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
aetna - medicare advantage
Workers Comp
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
EPO
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
HMO
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
Medicaid
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
Medicare Part A
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
Medicare Part B
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
POS
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
PPO
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield
Workers Comp
O
358.28
76.78
77.56
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
EPO
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
HMO
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
Medicaid
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
Medicare Part A
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
Medicare Part B
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
POS
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
PPO
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
blue cross blue shield - medicare advantage
Workers Comp
O
358.28
76.78
76.78
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
EPO
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
HMO
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
Medicaid
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
Medicare Part A
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
Medicare Part B
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
POS
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
PPO
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
humana - medicare advantage
Workers Comp
O
358.28
76.78
234.21
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
EPO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
HMO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
Medicaid
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
Medicare Part A
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
Medicare Part B
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
POS
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
PPO
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
tricare
Workers Comp
O
358.28
76.78
224.22
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
EPO
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
HMO
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
Medicaid
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
Medicare Part A
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
Medicare Part B
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
POS
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
PPO
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
united healthcare
Workers Comp
O
358.28
76.78
268.71
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
EPO
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
HMO
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
Medicaid
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
Medicare Part A
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
Medicare Part B
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
POS
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
PPO
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94060
null
cpt
Measurement and graphic recording of the amount and speed of breathed air before and following medication administration
va
Workers Comp
O
358.28
76.78
234.20
268.71
214.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
EPO
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
HMO
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
Medicaid
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
Medicare Part A
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
Medicare Part B
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
POS
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
PPO
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield
Workers Comp
O
187.54
57.76
57.76
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
EPO
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
HMO
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
Medicaid
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
Medicare Part A
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
Medicare Part B
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
POS
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
PPO
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
blue cross blue shield - medicare advantage
Workers Comp
O
187.54
57.76
78.12
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
EPO
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
HMO
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
Medicaid
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
Medicare Part A
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
Medicare Part B
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
POS
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
PPO
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94640
null
cpt
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen
united healthcare
Workers Comp
O
187.54
57.76
203.13
203.13
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
EPO
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
HMO
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
Medicaid
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
Medicare Part A
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
Medicare Part B
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
POS
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
PPO
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna
Workers Comp
O
473.02
117.78
270.08
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
EPO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
HMO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
Medicaid
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
Medicare Part A
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
Medicare Part B
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
POS
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
PPO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
aetna - medicare advantage
Workers Comp
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
EPO
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
HMO
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
Medicaid
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
Medicare Part A
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
Medicare Part B
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
POS
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
PPO
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield
Workers Comp
O
473.02
117.78
117.78
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
EPO
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
HMO
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
Medicaid
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
Medicare Part A
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
Medicare Part B
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
POS
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
PPO
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
blue cross blue shield - medicare advantage
Workers Comp
O
473.02
117.78
120.85
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
EPO
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
HMO
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
Medicaid
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
Medicare Part A
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
Medicare Part B
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
POS
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
PPO
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
cigna
Workers Comp
O
473.02
117.78
315.80
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
EPO
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
HMO
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
Medicaid
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
Medicare Part A
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
Medicare Part B
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
POS
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
PPO
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
humana - medicare advantage
Workers Comp
O
473.02
117.78
224.22
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
EPO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
HMO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
Medicaid
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
Medicare Part A
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
Medicare Part B
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
POS
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
PPO
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
tricare
Workers Comp
O
473.02
117.78
234.21
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
EPO
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
HMO
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
Medicaid
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
Medicare Part A
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
Medicare Part B
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
POS
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
PPO
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
united healthcare
Workers Comp
O
473.02
117.78
337.88
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
EPO
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
HMO
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
Medicaid
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
Medicare Part A
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
Medicare Part B
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
POS
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
PPO
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94726
null
cpt
Determination of lung volumes using plethysmography
va
Workers Comp
O
473.02
117.78
234.20
337.88
283.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
EPO
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
HMO
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
Medicaid
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
Medicare Part A
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
Medicare Part B
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
POS
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
PPO
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
aetna
Workers Comp
O
205.90
51.27
117.56
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
EPO
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
HMO
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
Medicaid
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
Medicare Part A
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
Medicare Part B
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
POS
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
PPO
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield
Workers Comp
O
205.90
51.27
51.27
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
EPO
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
HMO
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
Medicaid
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
Medicare Part A
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
Medicare Part B
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
POS
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
PPO
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
blue cross blue shield - medicare advantage
Workers Comp
O
205.90
51.27
52.61
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
EPO
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
HMO
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
Medicaid
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
Medicare Part A
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
Medicare Part B
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
POS
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
PPO
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
cigna
Workers Comp
O
205.90
51.27
137.46
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
EPO
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
HMO
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
Medicaid
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
Medicare Part A
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
Medicare Part B
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
POS
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
PPO
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
94729
null
cpt
Measurement of lung diffusing capacity
united healthcare
Workers Comp
O
205.90
51.27
147.08
147.08
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
EPO
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
HMO
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
Medicaid
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
Medicare Part A
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
Medicare Part B
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
POS
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
PPO
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield
Workers Comp
I
25155.64
5372.25
7597.75
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
EPO
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
HMO
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
Medicaid
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
POS
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
PPO
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
blue cross blue shield - medicare advantage
Workers Comp
I
25155.64
5372.25
5512.48
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
EPO
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
HMO
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
Medicaid
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
Medicare Part A
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
Medicare Part B
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
POS
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
PPO
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
united healthcare
Workers Comp
I
25155.64
5372.25
18948.53
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
EPO
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
HMO
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
Medicaid
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
Medicare Part A
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
Medicare Part B
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
POS
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
PPO
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
948
null
ms-drg
signs and symptoms without mcc
va
Workers Comp
I
25155.64
5372.25
5372.25
18948.53
15093.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
EPO
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
HMO
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
Medicaid
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
Medicare Part A
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
Medicare Part B
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
POS
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
PPO
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
949
null
ms-drg
aftercare with cc/mcc
blue cross blue shield
Workers Comp
I
34542.45
13113.00
13113.00
13113.00
20725.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
EPO
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
HMO
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
Medicaid
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
Medicare Part A
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
Medicare Part B
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
POS
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
PPO
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
956
null
ms-drg
limb reattachment hip and femur procedures for multiple significant trauma
humana - medicare advantage
Workers Comp
I
68911.63
23272.56
23272.56
23272.56
41346.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
EPO
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
HMO
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
Medicaid
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
Medicare Part A
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
Medicare Part B
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
POS
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
PPO
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95805
null
cpt
Diagnostic test for sleep disorder
blue cross blue shield
Workers Comp
O
1813.07
1320.01
1320.01
1320.01
1087.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
EPO
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
HMO
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
Medicaid
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
Medicare Part A
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
Medicare Part B
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
POS
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
PPO
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
aetna
Workers Comp
O
1509.22
59.23
861.70
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
EPO
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
HMO
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
Medicaid
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
Medicare Part A
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
Medicare Part B
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
POS
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
PPO
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield
Workers Comp
O
1509.22
59.23
59.67
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
EPO
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
HMO
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
Medicaid
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
Medicare Part A
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
Medicare Part B
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
POS
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
PPO
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
blue cross blue shield - medicare advantage
Workers Comp
O
1509.22
59.23
59.23
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
EPO
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
HMO
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
Medicaid
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
Medicare Part A
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
Medicare Part B
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
POS
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
PPO
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
cigna
Workers Comp
O
1509.22
59.23
1037.78
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
EPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
HMO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
Medicaid
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
Medicare Part A
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
Medicare Part B
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
POS
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
PPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
geha
Workers Comp
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
EPO
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
HMO
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
Medicaid
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
Medicare Part A
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
Medicare Part B
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
POS
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
PPO
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
humana - medicare advantage
Workers Comp
O
1509.22
59.23
121.34
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
EPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
HMO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
Medicaid
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
Medicare Part A
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
Medicare Part B
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
POS
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
PPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
united healthcare
Workers Comp
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
EPO
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
HMO
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
Medicaid
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
Medicare Part A
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
Medicare Part B
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
POS
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
PPO
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
va
Workers Comp
O
1509.22
59.23
123.13
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
EPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
HMO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
Medicaid
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
Medicare Part A
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
Medicare Part B
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
POS
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
PPO
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95806
null
cpt
Unattended sleep study with recording of heart rate oxygen respiratory airflow and effort
worker comp
Workers Comp
O
1509.22
59.23
1078.02
1078.02
905.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
EPO
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
HMO
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
Medicaid
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
Medicare Part A
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
Medicare Part B
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
POS
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
PPO
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna
Workers Comp
O
3843.18
805.22
2294.77
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
EPO
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
HMO
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
Medicaid
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
Medicare Part A
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
Medicare Part B
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
POS
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
PPO
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
aetna - medicare advantage
Workers Comp
O
3843.18
805.22
814.63
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
EPO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
HMO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
Medicaid
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
Medicare Part A
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
Medicare Part B
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
POS
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
PPO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield
Workers Comp
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
EPO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
HMO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
Medicaid
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
Medicare Part A
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
Medicare Part B
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
POS
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
PPO
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
blue cross blue shield - medicare advantage
Workers Comp
O
3843.18
805.22
1555.10
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
EPO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
HMO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
Medicaid
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
Medicare Part A
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
Medicare Part B
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
POS
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
PPO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
humana - medicare advantage
Workers Comp
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
EPO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
HMO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
Medicaid
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
Medicare Part A
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
Medicare Part B
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
POS
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
PPO
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
tricare
Workers Comp
O
3843.18
805.22
805.22
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
EPO
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
HMO
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
Medicaid
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
Medicare Part A
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
Medicare Part B
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
POS
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
PPO
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95810
null
cpt
Sleep study
va
Workers Comp
O
3843.18
805.22
814.60
2294.77
966.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
EPO
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
HMO
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
Medicaid
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
Medicare Part A
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
Medicare Part B
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
POS
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
PPO
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
aetna
Workers Comp
O
3006.21
805.22
1743.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
EPO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
HMO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
Medicaid
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
Medicare Part A
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
Medicare Part B
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
POS
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
PPO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield
Workers Comp
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
EPO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
HMO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
Medicaid
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
Medicare Part A
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
Medicare Part B
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
POS
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
PPO
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
blue cross blue shield - medicare advantage
Workers Comp
O
3006.21
805.22
1492.74
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
EPO
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
HMO
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
Medicaid
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
Medicare Part A
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
Medicare Part B
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
POS
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
PPO
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
cigna
Workers Comp
O
3006.21
805.22
2363.26
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
EPO
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
HMO
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
Medicaid
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
Medicare Part A
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
Medicare Part B
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
POS
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
PPO
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
healthchoice
Workers Comp
O
3006.21
805.22
1491.97
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
EPO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
HMO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
Medicaid
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
Medicare Part A
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
Medicare Part B
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
POS
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
PPO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
humana - medicare advantage
Workers Comp
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
EPO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
HMO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
Medicaid
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
Medicare Part A
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
Medicare Part B
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
POS
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
PPO
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
tricare
Workers Comp
O
3006.21
805.22
805.22
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
EPO
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
HMO
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
Medicaid
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
Medicare Part A
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
Medicare Part B
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
POS
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
PPO
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
united healthcare
Workers Comp
O
3006.21
805.22
2745.14
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
EPO
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
HMO
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
Medicaid
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
Medicare Part A
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
Medicare Part B
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
POS
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
PPO
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95811
null
cpt
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube
va
Workers Comp
O
3006.21
805.22
814.60
2745.14
1803.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
EPO
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
HMO
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
Medicaid
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
Medicare Part A
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
Medicare Part B
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
POS
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
PPO
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
aetna - medicare advantage
Workers Comp
O
508.64
197.17
222.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
EPO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
HMO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
Medicaid
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
Medicare Part A
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
Medicare Part B
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
POS
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
PPO
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield
Workers Comp
O
508.64
197.17
735.68
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
EPO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
HMO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
Medicaid
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
Medicare Part A
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
Medicare Part B
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
POS
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
PPO
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
blue cross blue shield - medicare advantage
Workers Comp
O
508.64
197.17
239.10
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
EPO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
HMO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
Medicaid
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
Medicare Part A
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
Medicare Part B
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
POS
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
PPO
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
healthchoice
Workers Comp
O
508.64
197.17
197.17
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
EPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
HMO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
Medicaid
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
Medicare Part A
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
Medicare Part B
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
POS
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
PPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
humana - medicare advantage
Workers Comp
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
EPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
HMO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
Medicaid
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
Medicare Part A
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
Medicare Part B
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
POS
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
PPO
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
tricare
Workers Comp
O
508.64
197.17
224.22
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
EPO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
HMO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
Medicaid
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
Medicare Part A
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
Medicare Part B
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
POS
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
PPO
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95819
null
cpt
Measurement and recording of brain wave (EEG) activity awake and asleep
united healthcare
Workers Comp
O
508.64
197.17
363.32
735.68
305.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
EPO
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
HMO
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
Medicaid
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
Medicare Part A
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
Medicare Part B
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
POS
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
PPO
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
95910
null
cpt
Nerve transmission studies 7-8 studies
humana - medicare advantage
Workers Comp
O
365.70
234.21
234.21
234.21
219.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
EPO
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
HMO
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
Medicaid
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
Medicare Part A
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
Medicare Part B
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
POS
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
PPO
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield
Workers Comp
O
211.47
70.65
121.15
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
EPO
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
HMO
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
POS
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
PPO
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
211.47
70.65
70.65
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
EPO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
HMO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
Medicaid
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
Medicare Part A
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
Medicare Part B
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
POS
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
PPO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
humana - medicare advantage
Workers Comp
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
EPO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
HMO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
Medicaid
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
Medicare Part A
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
Medicare Part B
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
POS
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
PPO
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
tricare
Workers Comp
O
211.47
70.65
162.77
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
EPO
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
HMO
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
Medicaid
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
Medicare Part A
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
Medicare Part B
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
POS
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
PPO
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
united healthcare
Workers Comp
O
211.47
70.65
151.05
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
EPO
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
HMO
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
Medicaid
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
Medicare Part A
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
Medicare Part B
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
POS
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
PPO
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96360
null
cpt
Hydration infusion into a vein 31 minutes to 1 hour
va
Workers Comp
O
211.47
70.65
180.22
180.22
126.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
EPO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
HMO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
Medicaid
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
Medicare Part A
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
Medicare Part B
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
POS
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
PPO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
aetna
Workers Comp
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
EPO
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
HMO
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
Medicaid
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
Medicare Part A
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
Medicare Part B
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
POS
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
PPO
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield
Workers Comp
O
55.65
14.93
15.01
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
EPO
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
HMO
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
Medicaid
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
Medicare Part A
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
Medicare Part B
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
POS
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
PPO
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
blue cross blue shield - medicare advantage
Workers Comp
O
55.65
14.93
14.93
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
EPO
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
HMO
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
Medicaid
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
Medicare Part A
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
Medicare Part B
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
POS
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
PPO
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
humana - medicare advantage
Workers Comp
O
55.65
14.93
35.43
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
EPO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
HMO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
Medicaid
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
Medicare Part A
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
Medicare Part B
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
POS
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
PPO
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
tricare
Workers Comp
O
55.65
14.93
33.76
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
EPO
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
HMO
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
Medicaid
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
Medicare Part A
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
Medicare Part B
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
POS
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
PPO
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
united healthcare
Workers Comp
O
55.65
14.93
39.75
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
EPO
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
HMO
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
Medicaid
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
Medicare Part A
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
Medicare Part B
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
POS
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
PPO
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96361
null
cpt
Hydration infusion into a vein
va
Workers Comp
O
55.65
14.93
35.42
39.75
33.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
EPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
HMO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
Medicaid
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
Medicare Part A
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
Medicare Part B
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
POS
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
PPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna
Workers Comp
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
EPO
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
HMO
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
Medicaid
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
Medicare Part A
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
Medicare Part B
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
POS
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
PPO
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
aetna - medicare advantage
Workers Comp
O
292.56
75.80
165.02
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
EPO
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
HMO
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
Medicaid
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
Medicare Part A
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
Medicare Part B
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
POS
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
PPO
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield
Workers Comp
O
292.56
75.80
75.80
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
EPO
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
HMO
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
POS
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
PPO
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
292.56
75.80
81.44
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
EPO
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
HMO
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
Medicaid
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
Medicare Part A
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
Medicare Part B
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
POS
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
PPO
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
cigna
Workers Comp
O
292.56
75.80
205.08
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
EPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
HMO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
Medicaid
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
Medicare Part A
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
Medicare Part B
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
POS
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
PPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
humana - medicare advantage
Workers Comp
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
EPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
HMO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
Medicaid
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
Medicare Part A
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
Medicare Part B
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
POS
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
PPO
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
tricare
Workers Comp
O
292.56
75.80
162.77
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
EPO
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
HMO
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
Medicaid
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
Medicare Part A
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
Medicare Part B
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
POS
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
PPO
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare
Workers Comp
O
292.56
75.80
180.47
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
EPO
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
HMO
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
Medicaid
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
Medicare Part A
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
Medicare Part B
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
POS
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
PPO
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
united healthcare - medicare advantage
Workers Comp
O
292.56
75.80
159.52
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
EPO
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
HMO
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
Medicaid
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
Medicare Part A
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
Medicare Part B
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
POS
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
PPO
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96365
null
cpt
Infusion into a vein for therapy prevention or diagnosis up to 1 hour
va
Workers Comp
O
292.56
75.80
180.22
205.08
175.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
EPO
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
HMO
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
Medicaid
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
Medicare Part A
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
Medicare Part B
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
POS
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
PPO
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
aetna
Workers Comp
O
70.11
19.72
40.66
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
EPO
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
HMO
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
Medicaid
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
Medicare Part A
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
Medicare Part B
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
POS
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
PPO
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield
Workers Comp
O
70.11
19.72
25.38
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
EPO
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
HMO
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
Medicaid
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
Medicare Part A
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
Medicare Part B
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
POS
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
PPO
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
blue cross blue shield - medicare advantage
Workers Comp
O
70.11
19.72
19.72
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
EPO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
HMO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
Medicaid
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
Medicare Part A
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
Medicare Part B
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
POS
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
PPO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
humana - medicare advantage
Workers Comp
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
EPO
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
HMO
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
Medicaid
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
Medicare Part A
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
Medicare Part B
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
POS
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
PPO
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
tricare
Workers Comp
O
70.11
19.72
33.76
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
EPO
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
HMO
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
Medicaid
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
Medicare Part A
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
Medicare Part B
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
POS
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
PPO
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
united healthcare
Workers Comp
O
70.11
19.72
50.09
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
EPO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
HMO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
Medicaid
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
Medicare Part A
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
Medicare Part B
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
POS
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
PPO
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96366
null
cpt
Infusion into a vein for therapy prevention or diagnosis
va
Workers Comp
O
70.11
19.72
35.43
50.09
42.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
EPO
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
HMO
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
Medicaid
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
Medicare Part A
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
Medicare Part B
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
POS
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
PPO
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna
Workers Comp
O
111.30
26.46
64.55
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
EPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
HMO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
Medicaid
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
Medicare Part A
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
Medicare Part B
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
POS
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
PPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
aetna - medicare advantage
Workers Comp
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
EPO
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
HMO
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
Medicaid
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
Medicare Part A
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
Medicare Part B
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
POS
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
PPO
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield
Workers Comp
O
111.30
26.46
26.46
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
EPO
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
HMO
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
POS
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
PPO
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
111.30
26.46
29.84
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
EPO
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
HMO
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
Medicaid
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
Medicare Part A
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
Medicare Part B
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
POS
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
PPO
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
cigna
Workers Comp
O
111.30
26.46
74.31
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
EPO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
HMO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
Medicaid
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
Medicare Part A
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
Medicare Part B
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
POS
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
PPO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
humana - medicare advantage
Workers Comp
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
EPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
HMO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
Medicaid
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
Medicare Part A
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
Medicare Part B
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
POS
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
PPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
tricare
Workers Comp
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
EPO
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
HMO
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
Medicaid
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
Medicare Part A
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
Medicare Part B
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
POS
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
PPO
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare
Workers Comp
O
111.30
26.46
79.50
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
EPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
HMO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
Medicaid
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
Medicare Part A
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
Medicare Part B
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
POS
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
PPO
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
united healthcare - medicare advantage
Workers Comp
O
111.30
26.46
53.57
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
EPO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
HMO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
Medicaid
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
Medicare Part A
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
Medicare Part B
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
POS
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
PPO
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96367
null
cpt
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour
va
Workers Comp
O
111.30
26.46
54.88
79.50
66.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
EPO
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
HMO
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
Medicaid
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
Medicare Part A
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
Medicare Part B
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
POS
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
PPO
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
aetna
Workers Comp
O
75.68
17.90
43.89
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
EPO
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
HMO
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
Medicaid
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
Medicare Part A
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
Medicare Part B
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
POS
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
PPO
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
blue cross blue shield
Workers Comp
O
75.68
17.90
17.90
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
EPO
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
HMO
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
Medicaid
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
Medicare Part A
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
Medicare Part B
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
POS
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
PPO
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96368
null
cpt
Infusion into a vein for therapy prevention or diagnosis concurrent with another infusion
cigna
Workers Comp
O
75.68
17.90
50.53
50.53
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
EPO
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
HMO
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
Medicaid
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
Medicare Part A
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
Medicare Part B
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
POS
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
PPO
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna
Workers Comp
O
87.92
19.75
53.12
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
EPO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
HMO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
Medicaid
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
Medicare Part A
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
Medicare Part B
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
POS
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
PPO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
aetna - medicare advantage
Workers Comp
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
EPO
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
HMO
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
Medicaid
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
Medicare Part A
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
Medicare Part B
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
POS
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
PPO
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield
Workers Comp
O
87.92
19.75
20.61
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
EPO
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
HMO
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicaid
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
POS
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
PPO
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
19.75
19.75
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
EPO
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
HMO
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
Medicaid
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
Medicare Part A
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
Medicare Part B
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
POS
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
PPO
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
cigna
Workers Comp
O
87.92
19.75
62.22
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
EPO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
HMO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
Medicaid
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part A
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part B
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
POS
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
PPO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
humana - medicare advantage
Workers Comp
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
EPO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
HMO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
Medicaid
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
Medicare Part A
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
Medicare Part B
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
POS
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
PPO
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
tricare
Workers Comp
O
87.92
19.75
53.57
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
EPO
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
HMO
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
Medicaid
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
Medicare Part A
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
Medicare Part B
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
POS
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
PPO
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare
Workers Comp
O
87.92
19.75
62.81
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
EPO
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
HMO
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicaid
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicare Part A
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicare Part B
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
POS
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
PPO
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
united healthcare - medicare advantage
Workers Comp
O
87.92
19.75
52.50
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
EPO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
HMO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
Medicaid
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
Medicare Part A
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
Medicare Part B
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
POS
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
PPO
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96372
null
cpt
Injection beneath the skin or into muscle for therapy diagnosis or prevention
va
Workers Comp
O
87.92
19.75
54.88
62.81
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
EPO
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
HMO
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicaid
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicare Part A
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicare Part B
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
POS
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
PPO
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
aetna
Workers Comp
O
205.90
39.34
159.10
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
EPO
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
HMO
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicaid
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicare Part A
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicare Part B
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
POS
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
PPO
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Workers Comp
O
205.90
39.34
45.81
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
EPO
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
HMO
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicaid
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part A
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part B
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
POS
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
PPO
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Workers Comp
O
205.90
39.34
39.34
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
EPO
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
HMO
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicaid
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part A
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part B
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
POS
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
PPO
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Workers Comp
O
205.90
39.34
162.77
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
EPO
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
HMO
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicaid
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicare Part A
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicare Part B
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
POS
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
PPO
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
tricare
Workers Comp
O
205.90
39.34
180.23
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
EPO
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
HMO
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicaid
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicare Part A
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicare Part B
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
POS
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
PPO
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Workers Comp
O
205.90
39.34
179.72
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
EPO
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
HMO
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
Medicaid
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
Medicare Part A
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
Medicare Part B
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
POS
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
PPO
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96374
null
cpt
Injection of drug or substance into a vein for therapy diagnosis or prevention
va
Workers Comp
O
205.90
39.34
180.22
180.23
123.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
EPO
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
HMO
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicaid
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicare Part A
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
Medicare Part B
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
POS
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
PPO
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna
Workers Comp
O
83.47
20.41
48.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
EPO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
HMO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
Medicaid
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
Medicare Part A
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
Medicare Part B
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
POS
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
PPO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
aetna - medicare advantage
Workers Comp
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
EPO
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
HMO
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicaid
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicare Part A
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Medicare Part B
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
POS
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
PPO
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield
Workers Comp
O
83.47
20.41
20.41
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
EPO
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
HMO
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicaid
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part A
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Medicare Part B
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
POS
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
PPO
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
blue cross blue shield - medicare advantage
Workers Comp
O
83.47
20.41
20.94
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
EPO
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
HMO
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
Medicaid
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
Medicare Part A
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
Medicare Part B
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
POS
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
PPO
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
cigna
Workers Comp
O
83.47
20.41
55.73
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
EPO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
HMO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicaid
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part A
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Medicare Part B
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
POS
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
PPO
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
humana - medicare advantage
Workers Comp
O
83.47
20.41
35.43
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
EPO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
HMO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicaid
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicare Part A
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
Medicare Part B
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
POS
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
PPO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
tricare
Workers Comp
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
EPO
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
HMO
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicaid
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicare Part A
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Medicare Part B
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
POS
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
PPO
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare
Workers Comp
O
83.47
20.41
59.63
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
EPO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
HMO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicaid
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicare Part A
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
Medicare Part B
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
POS
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
PPO
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
united healthcare - medicare advantage
Workers Comp
O
83.47
20.41
33.76
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
EPO
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
HMO
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
Medicaid
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
Medicare Part A
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
Medicare Part B
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
POS
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
PPO
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96375
null
cpt
Injection of different drug or substance into a vein for therapy diagnosis or prevention
va
Workers Comp
O
83.47
20.41
70.85
70.85
50.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
EPO
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
HMO
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
Medicaid
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
Medicare Part A
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
Medicare Part B
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
POS
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
PPO
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
aetna
Workers Comp
O
44.52
7.67
25.82
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
EPO
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
HMO
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
Medicaid
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
Medicare Part A
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
Medicare Part B
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
POS
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
PPO
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield
Workers Comp
O
44.52
7.67
10.14
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
EPO
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
HMO
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
Medicaid
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
Medicare Part A
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
Medicare Part B
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
POS
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
PPO
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
blue cross blue shield - medicare advantage
Workers Comp
O
44.52
7.67
7.67
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
EPO
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
HMO
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
Medicaid
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
Medicare Part A
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
Medicare Part B
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
POS
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
PPO
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96377
null
cpt
Application of on-body injector for injection under skin
tricare
Workers Comp
O
44.52
7.67
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
EPO
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
HMO
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
Medicaid
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
Medicare Part A
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
Medicare Part B
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
POS
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
PPO
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
964
null
ms-drg
other multiple significant trauma with cc
humana - medicare advantage
Workers Comp
I
24391.72
7962.71
7962.71
7962.71
14635.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
EPO
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
HMO
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
Medicaid
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
Medicare Part A
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
Medicare Part B
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
POS
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
PPO
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna
Workers Comp
O
270.45
41.16
50.50
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
EPO
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
HMO
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
Medicaid
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
Medicare Part A
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
Medicare Part B
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
POS
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
PPO
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
aetna - medicare advantage
Workers Comp
O
270.45
41.16
41.16
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
EPO
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
HMO
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
Medicaid
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
Medicare Part A
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
Medicare Part B
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
POS
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
PPO
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield
Workers Comp
O
270.45
41.16
60.33
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
EPO
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
HMO
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicaid
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicare Part A
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicare Part B
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
POS
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
PPO
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
blue cross blue shield - medicare advantage
Workers Comp
O
270.45
41.16
53.78
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
EPO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
HMO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
Medicaid
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
Medicare Part A
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
Medicare Part B
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
POS
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
PPO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
humana - medicare advantage
Workers Comp
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
EPO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
HMO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
Medicaid
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
Medicare Part A
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
Medicare Part B
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
POS
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
PPO
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
tricare
Workers Comp
O
270.45
41.16
53.57
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
EPO
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
HMO
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
Medicaid
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
Medicare Part A
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
Medicare Part B
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
POS
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
PPO
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96401
null
cpt
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle
united healthcare
Workers Comp
O
270.45
41.16
193.19
193.19
162.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
EPO
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
HMO
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
Medicaid
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
Medicare Part A
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
Medicare Part B
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
POS
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
PPO
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna
Workers Comp
O
117.97
22.42
68.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
EPO
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
HMO
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
Medicaid
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
Medicare Part A
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
Medicare Part B
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
POS
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
PPO
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
aetna - medicare advantage
Workers Comp
O
117.97
22.42
26.28
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
EPO
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
HMO
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
Medicaid
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
Medicare Part A
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
Medicare Part B
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
POS
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
PPO
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield
Workers Comp
O
117.97
22.42
22.42
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
EPO
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
HMO
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicaid
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicare Part A
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
Medicare Part B
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
POS
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
PPO
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
blue cross blue shield - medicare advantage
Workers Comp
O
117.97
22.42
36.73
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
EPO
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
HMO
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
Medicaid
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
Medicare Part A
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
Medicare Part B
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
POS
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
PPO
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
humana - medicare advantage
Workers Comp
O
117.97
22.42
27.44
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
EPO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
HMO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
Medicaid
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
Medicare Part A
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
Medicare Part B
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
POS
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
PPO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
tricare
Workers Comp
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
EPO
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
HMO
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
Medicaid
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
Medicare Part A
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
Medicare Part B
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
POS
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
PPO
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare
Workers Comp
O
117.97
22.42
84.27
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
EPO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
HMO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
Medicaid
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
Medicare Part A
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
Medicare Part B
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
POS
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
PPO
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
united healthcare - medicare advantage
Workers Comp
O
117.97
22.42
53.57
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
EPO
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
HMO
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
Medicaid
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
Medicare Part A
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
Medicare Part B
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
POS
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
PPO
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96402
null
cpt
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle
va
Workers Comp
O
117.97
22.42
54.88
84.27
70.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
EPO
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
HMO
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
Medicaid
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
Medicare Part A
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
Medicare Part B
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
POS
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
PPO
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96406
null
cpt
Chemotherapy into a lesion more than 7 lesions
blue cross blue shield - medicare advantage
Workers Comp
O
541.00
535.55
535.55
535.55
324.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
EPO
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
HMO
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
Medicaid
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
Medicare Part A
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
Medicare Part B
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
POS
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
PPO
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
blue cross blue shield - medicare advantage
Workers Comp
O
399.56
105.35
105.35
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
EPO
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
HMO
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
Medicaid
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
Medicare Part A
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
Medicare Part B
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
POS
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
PPO
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
humana - medicare advantage
Workers Comp
O
399.56
105.35
162.77
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
EPO
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
HMO
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
Medicaid
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
Medicare Part A
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
Medicare Part B
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
POS
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
PPO
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
tricare
Workers Comp
O
399.56
105.35
180.23
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
EPO
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
HMO
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
Medicaid
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
Medicare Part A
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
Medicare Part B
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
POS
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
PPO
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96409
null
cpt
Infusion of chemotherapy into a vein using push technique
united healthcare
Workers Comp
O
399.56
105.35
285.41
285.41
239.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
EPO
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
HMO
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
Medicaid
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
Medicare Part A
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
Medicare Part B
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
POS
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
PPO
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
aetna
Workers Comp
O
224.82
40.54
130.40
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
EPO
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
HMO
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
Medicaid
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
Medicare Part A
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
Medicare Part B
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
POS
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
PPO
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield
Workers Comp
O
224.82
40.54
50.85
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
EPO
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
HMO
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
Medicaid
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
Medicare Part A
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
Medicare Part B
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
POS
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
PPO
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
blue cross blue shield - medicare advantage
Workers Comp
O
224.82
40.54
40.54
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
EPO
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
HMO
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
Medicaid
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
Medicare Part A
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
Medicare Part B
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
POS
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
PPO
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
cigna
Workers Comp
O
224.82
40.54
150.10
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
EPO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
HMO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
Medicaid
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
Medicare Part A
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
Medicare Part B
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
POS
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
PPO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
humana - medicare advantage
Workers Comp
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
EPO
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
HMO
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
Medicaid
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
Medicare Part A
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
Medicare Part B
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
POS
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
PPO
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
tricare
Workers Comp
O
224.82
40.54
53.57
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
EPO
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
HMO
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
Medicaid
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
Medicare Part A
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
Medicare Part B
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
POS
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
PPO
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
united healthcare
Workers Comp
O
224.82
40.54
160.59
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
EPO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
HMO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
Medicaid
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
Medicare Part A
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
Medicare Part B
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
POS
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
PPO
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96411
null
cpt
Infusion of different chemotherapy drug or substance into a vein
va
Workers Comp
O
224.82
40.54
54.88
160.59
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
EPO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
HMO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
Medicaid
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
Medicare Part A
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
Medicare Part B
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
POS
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
PPO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna
Workers Comp
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
EPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
HMO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
Medicaid
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
Medicare Part A
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
Medicare Part B
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
POS
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
PPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
aetna - medicare advantage
Workers Comp
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
EPO
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
HMO
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
Medicaid
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
Medicare Part A
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
Medicare Part B
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
POS
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
PPO
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield
Workers Comp
O
487.49
114.27
114.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
EPO
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
HMO
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
POS
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
PPO
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
487.49
114.27
126.04
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
EPO
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
HMO
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
Medicaid
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
Medicare Part A
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
Medicare Part B
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
POS
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
PPO
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
cigna
Workers Comp
O
487.49
114.27
335.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
EPO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
HMO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
Medicaid
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
Medicare Part A
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
Medicare Part B
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
POS
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
PPO
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
humana - medicare advantage
Workers Comp
O
487.49
114.27
275.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
EPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
HMO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
Medicaid
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
Medicare Part A
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
Medicare Part B
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
POS
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
PPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
tricare
Workers Comp
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
EPO
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
HMO
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
Medicaid
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
Medicare Part A
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
Medicare Part B
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
POS
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
PPO
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare
Workers Comp
O
487.49
114.27
348.21
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
EPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
HMO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
Medicaid
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
Medicare Part A
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
Medicare Part B
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
POS
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
PPO
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
united healthcare - medicare advantage
Workers Comp
O
487.49
114.27
274.27
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
EPO
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
HMO
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
Medicaid
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
Medicare Part A
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
Medicare Part B
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
POS
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
PPO
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96413
null
cpt
Infusion of chemotherapy into a vein up to 1 hour
va
Workers Comp
O
487.49
114.27
275.20
348.21
292.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
EPO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
HMO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
Medicaid
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
Medicare Part A
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
Medicare Part B
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
POS
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
PPO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna
Workers Comp
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
EPO
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
HMO
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
Medicaid
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
Medicare Part A
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
Medicare Part B
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
POS
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
PPO
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
aetna - medicare advantage
Workers Comp
O
104.62
26.02
107.14
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
EPO
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
HMO
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
Medicaid
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
Medicare Part A
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
Medicare Part B
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
POS
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
PPO
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield
Workers Comp
O
104.62
26.02
26.02
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
EPO
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
HMO
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
Medicaid
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
Medicare Part A
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
Medicare Part B
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
POS
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
PPO
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
blue cross blue shield - medicare advantage
Workers Comp
O
104.62
26.02
34.08
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
EPO
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
HMO
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
Medicaid
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
Medicare Part A
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
Medicare Part B
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
POS
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
PPO
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
cigna
Workers Comp
O
104.62
26.02
69.85
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
EPO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
HMO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
Medicaid
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
Medicare Part A
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
Medicare Part B
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
POS
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
PPO
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
humana - medicare advantage
Workers Comp
O
104.62
26.02
54.88
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
EPO
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
HMO
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
Medicaid
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
Medicare Part A
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
Medicare Part B
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
POS
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
PPO
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
tricare
Workers Comp
O
104.62
26.02
53.57
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
EPO
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
HMO
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
Medicaid
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
Medicare Part A
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
Medicare Part B
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
POS
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
PPO
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
united healthcare
Workers Comp
O
104.62
26.02
74.73
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
EPO
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
HMO
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
Medicaid
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
Medicare Part A
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
Medicare Part B
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
POS
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
PPO
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96415
null
cpt
Infusion of chemotherapy into a vein
va
Workers Comp
O
104.62
26.02
109.76
109.76
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
EPO
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
HMO
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
Medicaid
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
Medicare Part A
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
Medicare Part B
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
POS
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
PPO
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
aetna
Workers Comp
O
505.30
118.39
293.07
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
EPO
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
HMO
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
Medicaid
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
Medicare Part A
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
Medicare Part B
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
POS
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
PPO
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield
Workers Comp
O
505.30
118.39
118.39
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
EPO
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
HMO
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
Medicaid
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
Medicare Part A
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
Medicare Part B
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
POS
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
PPO
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
blue cross blue shield - medicare advantage
Workers Comp
O
505.30
118.39
147.85
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
EPO
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
HMO
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
Medicaid
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
Medicare Part A
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
Medicare Part B
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
POS
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
PPO
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
cigna
Workers Comp
O
505.30
118.39
337.35
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
EPO
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
HMO
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
Medicaid
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
Medicare Part A
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
Medicare Part B
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
POS
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
PPO
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
humana - medicare advantage
Workers Comp
O
505.30
118.39
274.74
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
EPO
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
HMO
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
Medicaid
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
Medicare Part A
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
Medicare Part B
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
POS
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
PPO
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
tricare
Workers Comp
O
505.30
118.39
274.27
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
EPO
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
HMO
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
Medicaid
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
Medicare Part A
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
Medicare Part B
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
POS
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
PPO
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96416
null
cpt
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours
va
Workers Comp
O
505.30
118.39
275.20
337.35
303.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
EPO
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
HMO
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
Medicaid
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
Medicare Part A
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
Medicare Part B
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
POS
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
PPO
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna
Workers Comp
O
228.16
53.57
132.33
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
EPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
HMO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
Medicaid
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
Medicare Part A
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
Medicare Part B
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
POS
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
PPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
aetna - medicare advantage
Workers Comp
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
EPO
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
HMO
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
Medicaid
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
Medicare Part A
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
Medicare Part B
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
POS
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
PPO
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield
Workers Comp
O
228.16
53.57
65.16
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
EPO
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
HMO
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicaid
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part A
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
Medicare Part B
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
POS
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
PPO
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
blue cross blue shield - medicare advantage
Workers Comp
O
228.16
53.57
57.42
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
EPO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
HMO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
Medicaid
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
Medicare Part A
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
Medicare Part B
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
POS
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
PPO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
humana - medicare advantage
Workers Comp
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
EPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
HMO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
Medicaid
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
Medicare Part A
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
Medicare Part B
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
POS
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
PPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
tricare
Workers Comp
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
EPO
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
HMO
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
Medicaid
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
Medicare Part A
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
Medicare Part B
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
POS
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
PPO
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare
Workers Comp
O
228.16
53.57
162.98
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
EPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
HMO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
Medicaid
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
Medicare Part A
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
Medicare Part B
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
POS
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
PPO
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
united healthcare - medicare advantage
Workers Comp
O
228.16
53.57
53.57
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
EPO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
HMO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
Medicaid
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
Medicare Part A
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
Medicare Part B
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
POS
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
PPO
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96417
null
cpt
Infusion of different chemotherapy drug or substance into a vein up to 1 hour
va
Workers Comp
O
228.16
53.57
54.88
162.98
136.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
EPO
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
HMO
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
Medicaid
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
Medicare Part A
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
Medicare Part B
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
POS
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
PPO
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna
Workers Comp
O
181.41
47.76
101.94
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
EPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
HMO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
Medicaid
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
Medicare Part A
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
Medicare Part B
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
POS
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
PPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
aetna - medicare advantage
Workers Comp
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
EPO
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
HMO
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
Medicaid
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
Medicare Part A
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
Medicare Part B
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
POS
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
PPO
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield
Workers Comp
O
181.41
47.76
130.55
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
EPO
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
HMO
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
Medicaid
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
Medicare Part A
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
Medicare Part B
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
POS
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
PPO
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
blue cross blue shield - medicare advantage
Workers Comp
O
181.41
47.76
92.05
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
EPO
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
HMO
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
Medicaid
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
Medicare Part A
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
Medicare Part B
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
POS
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
PPO
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
cigna
Workers Comp
O
181.41
47.76
121.12
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
EPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
HMO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
Medicaid
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
Medicare Part A
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
Medicare Part B
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
POS
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
PPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
humana - medicare advantage
Workers Comp
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
EPO
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
HMO
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
Medicaid
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
Medicare Part A
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
Medicare Part B
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
POS
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
PPO
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
tricare
Workers Comp
O
181.41
47.76
48.73
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
EPO
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
HMO
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
Medicaid
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
Medicare Part A
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
Medicare Part B
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
POS
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
PPO
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare
Workers Comp
O
181.41
47.76
129.59
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
EPO
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
HMO
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
Medicaid
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
Medicare Part A
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
Medicare Part B
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
POS
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
PPO
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
united healthcare - medicare advantage
Workers Comp
O
181.41
47.76
47.76
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
EPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
HMO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
Medicaid
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
Medicare Part A
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
Medicare Part B
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
POS
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
PPO
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
96523
null
cpt
Irrigation of implanted venous access drug delivery device
va
Workers Comp
O
181.41
47.76
49.29
130.55
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
EPO
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
HMO
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
Medicaid
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
Medicare Part A
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
Medicare Part B
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
POS
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
PPO
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna
Workers Comp
O
74.57
3.90
31.80
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
EPO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
HMO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
Medicaid
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
Medicare Part A
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
Medicare Part B
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
POS
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
PPO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
aetna - medicare advantage
Workers Comp
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
EPO
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
HMO
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
Medicaid
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
Medicare Part A
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
Medicare Part B
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
POS
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
PPO
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield
Workers Comp
O
74.57
3.90
36.28
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
EPO
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
HMO
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
Medicaid
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
Medicare Part A
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
Medicare Part B
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
POS
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
PPO
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
blue cross blue shield - medicare advantage
Workers Comp
O
74.57
3.90
27.64
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
EPO
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
HMO
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
Medicaid
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
Medicare Part A
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
Medicare Part B
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
POS
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
PPO
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
humana - medicare advantage
Workers Comp
O
74.57
3.90
4.08
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
EPO
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
HMO
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
Medicaid
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
Medicare Part A
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
Medicare Part B
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
POS
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
PPO
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
tricare
Workers Comp
O
74.57
3.90
5.68
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
EPO
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
HMO
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
Medicaid
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
Medicare Part A
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
Medicare Part B
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
POS
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
PPO
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
united healthcare
Workers Comp
O
74.57
3.90
55.93
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
EPO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
HMO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
Medicaid
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
Medicare Part A
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
Medicare Part B
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
POS
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
PPO
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97018
null
cpt
Application of hot wax bath to 1 or more areas
va
Workers Comp
O
74.57
3.90
3.90
55.93
44.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
POS
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
85.06
11.89
93.19
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
EPO
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
HMO
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
Medicaid
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part A
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part B
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
POS
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
PPO
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97032
null
cpt
Application of electrical stimulation to 1 or more areas each 15 minutes
humana - medicare advantage
Workers Comp
O
85.06
11.89
11.89
93.19
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
EPO
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
HMO
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
Medicaid
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
Medicare Part A
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
Medicare Part B
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
POS
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
PPO
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
aetna
Workers Comp
O
100.17
10.93
46.11
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
EPO
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
HMO
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
Medicaid
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part A
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part B
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
POS
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
PPO
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield
Workers Comp
O
100.17
10.93
47.22
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
POS
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
100.17
10.93
37.61
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
EPO
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
HMO
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
Medicaid
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part A
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part B
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
POS
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
PPO
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
humana - medicare advantage
Workers Comp
O
100.17
10.93
10.93
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
EPO
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
HMO
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
Medicaid
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
Medicare Part A
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
Medicare Part B
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
POS
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
PPO
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
tricare
Workers Comp
O
100.17
10.93
13.97
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
EPO
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
HMO
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
Medicaid
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
Medicare Part A
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
Medicare Part B
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
POS
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
PPO
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97035
null
cpt
Application of ultrasound to 1 or more areas each 15 minutes
united healthcare
Workers Comp
O
100.17
10.93
75.13
75.13
60.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
EPO
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
HMO
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
Medicaid
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
Medicare Part A
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
Medicare Part B
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
POS
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
PPO
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna
Workers Comp
O
163.61
24.45
94.89
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
EPO
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
HMO
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
Medicaid
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
Medicare Part A
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
Medicare Part B
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
POS
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
PPO
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
aetna - medicare advantage
Workers Comp
O
163.61
24.45
51.30
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
EPO
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
HMO
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
Medicaid
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
Medicare Part A
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
Medicare Part B
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
POS
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
PPO
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield
Workers Comp
O
163.61
24.45
67.81
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
EPO
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
HMO
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
Medicaid
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
Medicare Part A
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
Medicare Part B
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
POS
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
PPO
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
blue cross blue shield - medicare advantage
Workers Comp
O
163.61
24.45
53.70
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
EPO
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
HMO
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
Medicaid
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
Medicare Part A
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
Medicare Part B
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
POS
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
PPO
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
cigna
Workers Comp
O
163.61
24.45
109.23
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
EPO
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
HMO
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
Medicaid
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
Medicare Part A
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
Medicare Part B
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
POS
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
PPO
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
healthchoice
Workers Comp
O
163.61
24.45
44.29
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
EPO
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
HMO
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
Medicaid
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
Medicare Part A
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
Medicare Part B
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
POS
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
PPO
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
humana - medicare advantage
Workers Comp
O
163.61
24.45
24.86
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
EPO
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
HMO
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
Medicaid
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
Medicare Part A
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
Medicare Part B
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
POS
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
PPO
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
tricare
Workers Comp
O
163.61
24.45
29.66
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
EPO
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
HMO
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
Medicaid
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
Medicare Part A
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
Medicare Part B
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
POS
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
PPO
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
united healthcare
Workers Comp
O
163.61
24.45
116.87
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
EPO
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
HMO
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
Medicaid
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
Medicare Part A
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
Medicare Part B
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
POS
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
PPO
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
va
Workers Comp
O
163.61
24.45
24.45
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
EPO
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
HMO
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
Medicaid
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
Medicare Part A
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
Medicare Part B
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
POS
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
PPO
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
webtpa
Workers Comp
O
163.61
24.45
114.53
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
EPO
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
HMO
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
Medicaid
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
Medicare Part A
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
Medicare Part B
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
POS
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
PPO
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97110
null
cpt
Physical Therapy (PT)
worker comp
Workers Comp
O
163.61
24.45
40.77
116.87
31.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
EPO
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
HMO
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
Medicaid
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
Medicare Part A
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
Medicare Part B
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
POS
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
PPO
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
aetna
Workers Comp
O
163.61
30.19
91.93
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
EPO
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
HMO
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
Medicaid
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
Medicare Part A
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
Medicare Part B
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
POS
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
PPO
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield
Workers Comp
O
163.61
30.19
51.28
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
POS
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
163.61
30.19
51.90
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
EPO
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
HMO
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
Medicaid
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
Medicare Part A
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
Medicare Part B
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
POS
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
PPO
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
humana - medicare advantage
Workers Comp
O
163.61
30.19
30.19
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
EPO
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
HMO
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
Medicaid
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
Medicare Part A
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
Medicare Part B
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
POS
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
PPO
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
tricare
Workers Comp
O
163.61
30.19
34.02
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
EPO
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
HMO
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
Medicaid
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
Medicare Part A
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
Medicare Part B
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
POS
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
PPO
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
united healthcare
Workers Comp
O
163.61
30.19
122.71
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
EPO
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
HMO
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
Medicaid
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
Medicare Part A
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
Medicare Part B
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
POS
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
PPO
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
va
Workers Comp
O
163.61
30.19
31.18
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
EPO
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
HMO
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
Medicaid
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
Medicare Part A
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
Medicare Part B
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
POS
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
PPO
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97112
null
cpt
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function each 15 minutes
worker comp
Workers Comp
O
163.61
30.19
40.77
122.71
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
EPO
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
HMO
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
Medicaid
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
Medicare Part A
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
Medicare Part B
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
POS
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
PPO
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
aetna
Workers Comp
O
124.65
28.83
88.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
EPO
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
HMO
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
Medicaid
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part A
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part B
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
POS
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
PPO
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield
Workers Comp
O
124.65
28.83
56.54
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
POS
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
124.65
28.83
51.73
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
EPO
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
HMO
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
Medicaid
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part A
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part B
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
POS
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
PPO
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
humana - medicare advantage
Workers Comp
O
124.65
28.83
29.46
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
EPO
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
HMO
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
Medicaid
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
Medicare Part A
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
Medicare Part B
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
POS
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
PPO
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
tricare
Workers Comp
O
124.65
28.83
37.14
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
EPO
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
HMO
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
Medicaid
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
Medicare Part A
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
Medicare Part B
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
POS
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
PPO
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
united healthcare
Workers Comp
O
124.65
28.83
89.04
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
EPO
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
HMO
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
Medicaid
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
Medicare Part A
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
Medicare Part B
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
POS
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
PPO
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
va
Workers Comp
O
124.65
28.83
28.83
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
EPO
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
HMO
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
Medicaid
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
Medicare Part A
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
Medicare Part B
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
POS
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
PPO
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97113
null
cpt
Water pool therapy with therapeutic exercises to 1 or more areas each 15 minutes
webtpa
Workers Comp
O
124.65
28.83
87.26
89.04
74.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
EPO
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
HMO
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
Medicaid
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
Medicare Part A
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
Medicare Part B
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
POS
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
PPO
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna
Workers Comp
O
163.61
22.40
74.64
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
EPO
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
HMO
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
Medicaid
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
Medicare Part A
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
Medicare Part B
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
POS
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
PPO
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
aetna - medicare advantage
Workers Comp
O
163.61
22.40
45.44
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
EPO
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
HMO
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
Medicaid
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part A
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part B
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
POS
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
PPO
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield
Workers Comp
O
163.61
22.40
71.55
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
POS
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
163.61
22.40
60.73
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
EPO
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
HMO
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
Medicaid
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part A
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part B
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
POS
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
PPO
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
humana - medicare advantage
Workers Comp
O
163.61
22.40
23.10
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
EPO
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
HMO
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
Medicaid
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
Medicare Part A
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
Medicare Part B
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
POS
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
PPO
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
tricare
Workers Comp
O
163.61
22.40
29.34
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
EPO
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
HMO
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
Medicaid
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
Medicare Part A
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
Medicare Part B
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
POS
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
PPO
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
united healthcare
Workers Comp
O
163.61
22.40
116.87
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
EPO
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
HMO
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
Medicaid
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
Medicare Part A
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
Medicare Part B
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
POS
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
PPO
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
va
Workers Comp
O
163.61
22.40
22.40
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
EPO
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
HMO
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
Medicaid
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
Medicare Part A
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
Medicare Part B
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
POS
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
PPO
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97116
null
cpt
Walking training to 1 or more areas each 15 minutes
worker comp
Workers Comp
O
163.61
22.40
40.77
116.87
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
EPO
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
HMO
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
Medicaid
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
Medicare Part A
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
Medicare Part B
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
POS
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
PPO
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
aetna
Workers Comp
O
95.60
27.97
53.72
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
EPO
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
HMO
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
Medicaid
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part A
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
Medicare Part B
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
POS
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
PPO
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield
Workers Comp
O
95.60
27.97
44.46
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
POS
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
95.60
27.97
95.60
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
EPO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
HMO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
Medicaid
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part A
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
Medicare Part B
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
POS
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
PPO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
humana - medicare advantage
Workers Comp
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
EPO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
HMO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
Medicaid
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
Medicare Part A
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
Medicare Part B
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
POS
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
PPO
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
tricare
Workers Comp
O
95.60
27.97
27.97
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
EPO
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
HMO
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
Medicaid
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
Medicare Part A
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
Medicare Part B
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
POS
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
PPO
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97124
null
cpt
Therapeutic massage to 1 or more areas each 15 minutes
united healthcare
Workers Comp
O
95.60
27.97
71.70
95.60
57.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
EPO
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
HMO
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
Medicaid
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
Medicare Part A
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
Medicare Part B
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
POS
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
PPO
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna
Workers Comp
O
219.26
20.93
99.35
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
EPO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
HMO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
Medicaid
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
Medicare Part A
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
Medicare Part B
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
POS
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
PPO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
aetna - medicare advantage
Workers Comp
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
EPO
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
HMO
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
Medicaid
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
Medicare Part A
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
Medicare Part B
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
POS
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
PPO
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield
Workers Comp
O
219.26
20.93
89.08
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
POS
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
219.26
20.93
67.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
EPO
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
HMO
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
Medicaid
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
Medicare Part A
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
Medicare Part B
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
POS
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
PPO
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
cigna
Workers Comp
O
219.26
20.93
146.38
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
EPO
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
HMO
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
Medicaid
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
Medicare Part A
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
Medicare Part B
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
POS
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
PPO
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
healthchoice
Workers Comp
O
219.26
20.93
27.12
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
EPO
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
HMO
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
Medicaid
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
Medicare Part A
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
Medicare Part B
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
POS
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
PPO
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
humana - medicare advantage
Workers Comp
O
219.26
20.93
21.74
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
EPO
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
HMO
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
Medicaid
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
Medicare Part A
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
Medicare Part B
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
POS
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
PPO
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
tricare
Workers Comp
O
219.26
20.93
27.33
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
EPO
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
HMO
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
Medicaid
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
Medicare Part A
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
Medicare Part B
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
POS
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
PPO
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
united healthcare
Workers Comp
O
219.26
20.93
160.54
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
EPO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
HMO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
Medicaid
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
Medicare Part A
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
Medicare Part B
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
POS
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
PPO
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
va
Workers Comp
O
219.26
20.93
20.93
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
EPO
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
HMO
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
Medicaid
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
Medicare Part A
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
Medicare Part B
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
POS
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
PPO
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97140
null
cpt
Manual (physical) therapy techniques to 1 or more regions each 15 minutes
worker comp
Workers Comp
O
219.26
20.93
54.63
160.54
131.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
EPO
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
HMO
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
Medicaid
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
Medicare Part A
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
Medicare Part B
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
POS
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
PPO
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna
Workers Comp
O
177.45
59.22
102.92
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
EPO
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
HMO
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
Medicaid
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
Medicare Part A
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
Medicare Part B
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
POS
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
PPO
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
aetna - medicare advantage
Workers Comp
O
177.45
59.22
81.70
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
EPO
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
HMO
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
Medicaid
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
Medicare Part A
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
Medicare Part B
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
POS
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
PPO
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield
Workers Comp
O
177.45
59.22
67.49
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
EPO
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
HMO
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
Medicaid
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
POS
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
PPO
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
177.45
59.22
59.22
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
EPO
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
HMO
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
Medicaid
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
Medicare Part A
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
Medicare Part B
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
POS
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
PPO
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
cigna
Workers Comp
O
177.45
59.22
125.57
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
EPO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
HMO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
Medicaid
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
Medicare Part A
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
Medicare Part B
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
POS
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
PPO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
humana - medicare advantage
Workers Comp
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
EPO
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
HMO
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
Medicaid
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
Medicare Part A
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
Medicare Part B
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
POS
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
PPO
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
tricare
Workers Comp
O
177.45
59.22
82.61
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
EPO
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
HMO
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
Medicaid
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
Medicare Part A
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
Medicare Part B
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
POS
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
PPO
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
united healthcare
Workers Comp
O
177.45
59.22
126.75
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
EPO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
HMO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
Medicaid
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
Medicare Part A
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
Medicare Part B
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
POS
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
PPO
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97161
null
cpt
Evaluation of physical therapy typically 20 minutes
va
Workers Comp
O
177.45
59.22
95.98
126.75
106.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
EPO
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
HMO
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
Medicaid
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
Medicare Part A
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
Medicare Part B
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
POS
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
PPO
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
aetna
Workers Comp
O
212.10
58.86
119.18
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
EPO
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
HMO
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
Medicaid
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
Medicare Part A
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
Medicare Part B
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
POS
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
PPO
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield
Workers Comp
O
212.10
58.86
70.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
EPO
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
HMO
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicaid
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
POS
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
PPO
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
212.10
58.86
58.86
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
EPO
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
HMO
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
Medicaid
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
Medicare Part A
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
Medicare Part B
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
POS
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
PPO
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
cigna
Workers Comp
O
212.10
58.86
141.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
EPO
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
HMO
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
Medicaid
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
Medicare Part A
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
Medicare Part B
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
POS
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
PPO
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
humana - medicare advantage
Workers Comp
O
212.10
58.86
82.60
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
EPO
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
HMO
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
Medicaid
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
Medicare Part A
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
Medicare Part B
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
POS
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
PPO
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
tricare
Workers Comp
O
212.10
58.86
82.61
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
EPO
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
HMO
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
Medicaid
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
Medicare Part A
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
Medicare Part B
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
POS
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
PPO
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
united healthcare
Workers Comp
O
212.10
58.86
151.50
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
EPO
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
HMO
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
Medicaid
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
Medicare Part A
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
Medicare Part B
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
POS
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
PPO
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97162
null
cpt
Evaluation of physical therapy typically 30 minutes
va
Workers Comp
O
212.10
58.86
95.98
151.50
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
EPO
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
HMO
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
Medicaid
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
Medicare Part A
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
Medicare Part B
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
POS
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
PPO
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna
Workers Comp
O
265.65
43.15
151.68
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
EPO
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
HMO
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
Medicaid
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
Medicare Part A
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
Medicare Part B
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
POS
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
PPO
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
aetna - medicare advantage
Workers Comp
O
265.65
43.15
81.47
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
EPO
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
HMO
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
Medicaid
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
Medicare Part A
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
Medicare Part B
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
POS
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
PPO
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield
Workers Comp
O
265.65
43.15
57.36
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
EPO
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
HMO
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicaid
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
POS
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
PPO
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
265.65
43.15
43.15
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
EPO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
HMO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
Medicaid
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
Medicare Part A
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
Medicare Part B
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
POS
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
PPO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
humana - medicare advantage
Workers Comp
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
EPO
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
HMO
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
Medicaid
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
Medicare Part A
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
Medicare Part B
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
POS
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
PPO
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
tricare
Workers Comp
O
265.65
43.15
82.61
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
EPO
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
HMO
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
Medicaid
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
Medicare Part A
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
Medicare Part B
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
POS
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
PPO
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
united healthcare
Workers Comp
O
265.65
43.15
189.75
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
EPO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
HMO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
Medicaid
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
Medicare Part A
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
Medicare Part B
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
POS
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
PPO
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97163
null
cpt
Evaluation of physical therapy typically 45 minutes
va
Workers Comp
O
265.65
43.15
95.98
189.75
159.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
EPO
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
HMO
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
Medicaid
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
Medicare Part A
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
Medicare Part B
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
POS
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
PPO
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield
Workers Comp
O
211.24
67.29
98.56
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
EPO
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
HMO
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicaid
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
POS
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
PPO
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
211.24
67.29
67.29
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
EPO
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
HMO
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
Medicaid
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
Medicare Part A
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
Medicare Part B
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
POS
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
PPO
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97165
null
cpt
Evaluation of occupational therapy typically 30 minutes
tricare
Workers Comp
O
211.24
67.29
93.22
98.56
126.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
EPO
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
HMO
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
Medicaid
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
Medicare Part A
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
Medicare Part B
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
POS
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
PPO
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna
Workers Comp
O
250.42
83.18
145.24
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
EPO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
HMO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
Medicaid
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
Medicare Part A
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
Medicare Part B
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
POS
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
PPO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
aetna - medicare advantage
Workers Comp
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
EPO
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
HMO
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
Medicaid
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
Medicare Part A
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
Medicare Part B
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
POS
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
PPO
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield
Workers Comp
O
250.42
83.18
112.76
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
EPO
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
HMO
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicaid
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
POS
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
PPO
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
250.42
83.18
83.18
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
EPO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
HMO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
Medicaid
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
Medicare Part A
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
Medicare Part B
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
POS
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
PPO
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
humana - medicare advantage
Workers Comp
O
250.42
83.18
93.22
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
EPO
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
HMO
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
Medicaid
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
Medicare Part A
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
Medicare Part B
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
POS
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
PPO
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
tricare
Workers Comp
O
250.42
83.18
87.08
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
EPO
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
HMO
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
Medicaid
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
Medicare Part A
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
Medicare Part B
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
POS
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
PPO
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
united healthcare
Workers Comp
O
250.42
83.18
178.88
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
EPO
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
HMO
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
Medicaid
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
Medicare Part A
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
Medicare Part B
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
POS
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
PPO
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97166
null
cpt
Evaluation of occupational therapy typically 45 minutes
va
Workers Comp
O
250.42
83.18
90.45
178.88
150.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
EPO
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
HMO
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
Medicaid
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
Medicare Part A
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
Medicare Part B
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
POS
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
PPO
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield
Workers Comp
O
317.20
87.38
135.76
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
EPO
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
HMO
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
Medicaid
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
POS
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
PPO
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
317.20
87.38
102.94
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
EPO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
HMO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
Medicaid
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
Medicare Part A
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
Medicare Part B
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
POS
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
PPO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
humana - medicare advantage
Workers Comp
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
EPO
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
HMO
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
Medicaid
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
Medicare Part A
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
Medicare Part B
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
POS
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
PPO
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
tricare
Workers Comp
O
317.20
87.38
87.38
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
EPO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
HMO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
Medicaid
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
Medicare Part A
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
Medicare Part B
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
POS
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
PPO
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97167
null
cpt
Evaluation of occupational therapy established plan of care typically 60 minutes
va
Workers Comp
O
317.20
87.38
93.22
135.76
190.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
EPO
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
HMO
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
Medicaid
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
Medicare Part A
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
Medicare Part B
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
POS
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
PPO
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
974
null
ms-drg
hiv with major related condition with mcc
humana - medicare advantage
Workers Comp
I
34161.45
15919.30
15919.30
15919.30
20496.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
EPO
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
HMO
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
Medicaid
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
Medicare Part A
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
Medicare Part B
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
POS
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
PPO
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna
Workers Comp
O
156.93
36.50
89.60
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
EPO
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
HMO
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
Medicaid
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
Medicare Part A
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
Medicare Part B
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
POS
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
PPO
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
aetna - medicare advantage
Workers Comp
O
156.93
36.50
36.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
EPO
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
HMO
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
Medicaid
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
Medicare Part A
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
Medicare Part B
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
POS
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
PPO
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield
Workers Comp
O
156.93
36.50
62.41
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
POS
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
156.93
36.50
51.84
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
EPO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
HMO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
Medicaid
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
Medicare Part A
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
Medicare Part B
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
POS
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
PPO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
humana - medicare advantage
Workers Comp
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
EPO
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
HMO
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
Medicaid
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
Medicare Part A
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
Medicare Part B
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
POS
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
PPO
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
tricare
Workers Comp
O
156.93
36.50
37.61
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
EPO
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
HMO
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
Medicaid
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
Medicare Part A
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
Medicare Part B
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
POS
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
PPO
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
united healthcare
Workers Comp
O
156.93
36.50
114.90
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
EPO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
HMO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
Medicaid
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
Medicare Part A
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
Medicare Part B
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
POS
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
PPO
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97530
null
cpt
Therapeutic activities to improve function with one-on-one contact between patient and provider each 15 minutes
va
Workers Comp
O
156.93
36.50
36.50
114.90
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
EPO
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
HMO
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
Medicaid
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
Medicare Part A
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
Medicare Part B
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
POS
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
PPO
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
aetna
Workers Comp
O
189.21
32.96
84.86
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
EPO
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
HMO
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
Medicaid
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
Medicare Part A
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
Medicare Part B
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
POS
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
PPO
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield
Workers Comp
O
189.21
32.96
58.45
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
EPO
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
HMO
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
POS
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
PPO
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
189.21
32.96
78.50
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
EPO
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
HMO
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
Medicaid
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
Medicare Part A
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
Medicare Part B
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
POS
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
PPO
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97535
null
cpt
Self-care or home management training each 15 minutes
tricare
Workers Comp
O
189.21
32.96
32.96
84.86
113.53


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
EPO
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
HMO
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
Medicaid
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
Medicare Part A
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
Medicare Part B
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
POS
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
PPO
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna
Workers Comp
O
563.17
21.43
21.43
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
EPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
HMO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
Medicaid
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
Medicare Part A
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
Medicare Part B
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
POS
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
PPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
aetna - medicare advantage
Workers Comp
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
EPO
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
HMO
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
Medicaid
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
Medicare Part A
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
Medicare Part B
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
POS
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
PPO
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield
Workers Comp
O
563.17
21.43
94.40
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
EPO
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
HMO
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
Medicaid
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
Medicare Part A
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
Medicare Part B
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
POS
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
PPO
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
blue cross blue shield - medicare advantage
Workers Comp
O
563.17
21.43
100.22
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
EPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
HMO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
Medicaid
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
Medicare Part A
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
Medicare Part B
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
POS
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
PPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
humana - medicare advantage
Workers Comp
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
EPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
HMO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
Medicaid
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
Medicare Part A
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
Medicare Part B
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
POS
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
PPO
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
tricare
Workers Comp
O
563.17
21.43
154.79
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
EPO
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
HMO
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
Medicaid
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
Medicare Part A
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
Medicare Part B
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
POS
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
PPO
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare
Workers Comp
O
563.17
21.43
402.30
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
EPO
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
HMO
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
Medicaid
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
Medicare Part A
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
Medicare Part B
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
POS
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
PPO
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
united healthcare - medicare advantage
Workers Comp
O
563.17
21.43
151.70
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
EPO
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
HMO
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
Medicaid
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
Medicare Part A
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
Medicare Part B
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
POS
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
PPO
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97597
null
cpt
Removal of tissue from wounds per session first 20 sq cms or less
va
Workers Comp
O
563.17
21.43
79.51
402.30
337.90


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
EPO
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
HMO
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
Medicaid
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
Medicare Part A
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
Medicare Part B
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
POS
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
PPO
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
blue cross blue shield
Workers Comp
O
1681.19
337.67
7486.83
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
EPO
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
HMO
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicaid
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicare Part A
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicare Part B
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
POS
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
PPO
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Workers Comp
O
1681.19
337.67
337.67
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
EPO
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
HMO
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
Medicaid
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
Medicare Part A
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
Medicare Part B
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
POS
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
PPO
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97605
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
va
Workers Comp
O
1681.19
337.67
464.21
7486.83
1008.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
EPO
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
HMO
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
Medicaid
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
Medicare Part A
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
Medicare Part B
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
POS
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
PPO
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield
Workers Comp
O
3435.68
556.91
753.79
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
EPO
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
HMO
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
Medicaid
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
Medicare Part A
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
Medicare Part B
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
POS
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
PPO
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97606
null
cpt
Negative pressure wound therapy surface area greater than 50 square centimeters per session
blue cross blue shield - medicare advantage
Workers Comp
O
3435.68
556.91
556.91
753.79
2061.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
EPO
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
HMO
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicaid
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicare Part A
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Medicare Part B
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
POS
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
PPO
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97607
null
cpt
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session
humana - medicare advantage
Workers Comp
O
2727.19
581.83
581.83
581.83
1636.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
EPO
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
HMO
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
Medicaid
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
Medicare Part A
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
Medicare Part B
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
POS
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
PPO
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
humana - medicare advantage
Workers Comp
O
49.63
32.13
32.13
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
EPO
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
HMO
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
Medicaid
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
Medicare Part A
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
Medicare Part B
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
POS
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
PPO
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
97760
null
cpt
Training in use of orthotics (supports braces or splints) for arms legs and/or trunk per 15 minutes
tricare
Workers Comp
O
49.63
32.13
46.81
46.81
29.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
EPO
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
HMO
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
Medicaid
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
Medicare Part A
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
Medicare Part B
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
POS
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
PPO
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
aetna - medicare advantage
Workers Comp
I
90654.67
22316.33
22316.33
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
EPO
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
HMO
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
Medicaid
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
Medicare Part A
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
Medicare Part B
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
POS
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
PPO
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
981
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with mcc
humana - medicare advantage
Workers Comp
I
90654.67
22316.33
36432.96
36432.96
54392.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
EPO
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
HMO
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
Medicaid
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
Medicare Part A
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
Medicare Part B
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
POS
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
PPO
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
humana - medicare advantage
Workers Comp
I
46398.03
2771.51
13404.57
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
EPO
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
HMO
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
Medicaid
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
Medicare Part A
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
Medicare Part B
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
POS
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
PPO
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
982
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis with cc
tricare
Workers Comp
I
46398.03
2771.51
2771.51
13404.57
27838.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
EPO
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
HMO
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
Medicaid
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
Medicare Part A
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
Medicare Part B
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
POS
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
PPO
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
983
null
ms-drg
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
tricare
Workers Comp
I
36362.37
8044.15
8044.15
8044.15
21817.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
EPO
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
HMO
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
Medicaid
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part A
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
Medicare Part B
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
POS
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
PPO
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
blue cross blue shield
Workers Comp
I
19663.35
7207.62
10770.23
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
EPO
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
HMO
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
Medicaid
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
Medicare Part A
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
Medicare Part B
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
POS
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
PPO
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
989
null
ms-drg
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc
humana - medicare advantage
Workers Comp
I
19663.35
7207.62
7207.62
10770.23
11798.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
EPO
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
HMO
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
Medicaid
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
Medicare Part A
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
Medicare Part B
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
POS
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
PPO
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99070
null
cpt
Supplies and materials provided by the physician beyond those usually included in the office visit or service
tricare
Workers Comp
O
94.96
94.96
94.96
94.96
56.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
EPO
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
HMO
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
Medicaid
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
Medicare Part A
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
Medicare Part B
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
POS
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
PPO
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99078
null
cpt
Physician educational services provided in a group setting
tricare
Workers Comp
O
2947.87
2947.87
2947.87
2947.87
1768.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
EPO
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
HMO
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
Medicaid
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
Medicare Part A
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
Medicare Part B
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
POS
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
PPO
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield
Workers Comp
O
44.52
6.47
6.47
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
EPO
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
HMO
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
POS
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
PPO
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
44.52
6.47
15.72
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
EPO
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
HMO
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
Medicaid
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
Medicare Part A
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
Medicare Part B
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
POS
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
PPO
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99152
null
cpt
Moderate sedation services by physician also performing a procedure patient 5 years of age or older first 15 minutes
united healthcare
Workers Comp
O
44.52
6.47
31.80
31.80
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
EPO
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
HMO
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
Medicaid
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
Medicare Part A
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
Medicare Part B
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
POS
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
PPO
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
aetna
Workers Comp
O
44.52
4.86
25.02
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
EPO
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
HMO
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
Medicaid
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
Medicare Part A
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
Medicare Part B
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
POS
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
PPO
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield
Workers Comp
O
44.52
4.86
4.86
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
EPO
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
HMO
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
POS
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
PPO
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
44.52
4.86
15.08
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
EPO
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
HMO
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
Medicaid
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
Medicare Part A
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
Medicare Part B
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
POS
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
PPO
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
united healthcare
Workers Comp
O
44.52
4.86
33.39
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
EPO
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
HMO
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
Medicaid
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
Medicare Part A
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
Medicare Part B
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
POS
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
PPO
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99153
null
cpt
Moderate sedation services by physician also performing a procedure additional 15 minutes
va
Workers Comp
O
44.52
4.86
42.40
42.40
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
EPO
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
HMO
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
Medicaid
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
Medicare Part A
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
Medicare Part B
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
POS
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
PPO
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield
Workers Comp
O
264.02
29.78
29.78
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
EPO
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
HMO
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
Medicaid
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
POS
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
PPO
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99202
null
cpt
New patient office or other outpatient visit typically 20 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
264.02
29.78
88.72
88.72
158.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
EPO
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
HMO
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
Medicaid
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
Medicare Part A
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
Medicare Part B
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
POS
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
PPO
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield
Workers Comp
O
412.92
128.11
177.55
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
EPO
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
HMO
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
Medicaid
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
Medicare Part A
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
Medicare Part B
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
POS
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
PPO
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
blue cross blue shield - medicare advantage
Workers Comp
O
412.92
128.11
128.11
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
EPO
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
HMO
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
Medicaid
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
Medicare Part A
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
Medicare Part B
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
POS
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
PPO
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
united healthcare
Workers Comp
O
412.92
128.11
294.95
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
EPO
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
HMO
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
Medicaid
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
Medicare Part A
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
Medicare Part B
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
POS
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
PPO
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99203
null
cpt
Office visit typically 30 min
webtpa
Workers Comp
O
412.92
128.11
275.28
294.95
209.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
EPO
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
HMO
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
Medicaid
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
Medicare Part A
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
Medicare Part B
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
POS
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
PPO
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
aetna
Workers Comp
O
604.20
37.88
367.96
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
EPO
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
HMO
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
Medicaid
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
Medicare Part A
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
Medicare Part B
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
POS
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
PPO
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield
Workers Comp
O
604.20
37.88
176.76
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
EPO
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
HMO
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
Medicaid
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
Medicare Part A
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
Medicare Part B
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
POS
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
PPO
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
blue cross blue shield - medicare advantage
Workers Comp
O
604.20
37.88
37.88
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
EPO
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
HMO
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
Medicaid
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
Medicare Part A
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
Medicare Part B
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
POS
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
PPO
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
united healthcare
Workers Comp
O
604.20
37.88
464.48
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
EPO
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
HMO
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
Medicaid
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
Medicare Part A
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
Medicare Part B
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
POS
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
PPO
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
webtpa
Workers Comp
O
604.20
37.88
444.09
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
EPO
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
HMO
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
Medicaid
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
Medicare Part A
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
Medicare Part B
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
POS
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
PPO
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99204
null
cpt
Office visit typically 45 min
worker comp
Workers Comp
O
604.20
37.88
453.15
464.48
217.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
EPO
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
HMO
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
Medicaid
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
Medicare Part A
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
Medicare Part B
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
POS
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
PPO
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
blue cross blue shield
Workers Comp
O
577.03
77.78
77.78
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
EPO
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
HMO
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
Medicaid
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
Medicare Part A
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
Medicare Part B
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
POS
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
PPO
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99205
null
cpt
Office visit typically 60 min
united healthcare - medicare advantage
Workers Comp
O
577.03
77.78
122.24
122.24
346.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
EPO
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
HMO
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
Medicaid
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
Medicare Part A
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
Medicare Part B
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
POS
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
PPO
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
aetna
Workers Comp
O
82.04
4.56
51.00
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
EPO
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
HMO
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
Medicaid
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
Medicare Part A
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
Medicare Part B
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
POS
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
PPO
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield
Workers Comp
O
82.04
4.56
45.79
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
EPO
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
HMO
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
Medicaid
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
POS
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
PPO
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
82.04
4.56
62.64
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
EPO
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
HMO
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
Medicaid
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
Medicare Part A
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
Medicare Part B
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
POS
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
PPO
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
healthchoice
Workers Comp
O
82.04
4.56
4.56
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
EPO
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
HMO
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
Medicaid
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
Medicare Part A
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
Medicare Part B
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
POS
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
PPO
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
united healthcare
Workers Comp
O
82.04
4.56
61.53
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
EPO
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
HMO
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
Medicaid
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
Medicare Part A
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
Medicare Part B
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
POS
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
PPO
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99211
null
cpt
Established patient office or other outpatient visit typically 5 minutes
webtpa
Workers Comp
O
82.04
4.56
47.24
62.64
49.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
EPO
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
HMO
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
Medicaid
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
Medicare Part A
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
Medicare Part B
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
POS
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
PPO
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
aetna
Workers Comp
O
161.86
6.47
98.57
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
EPO
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
HMO
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
Medicaid
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
Medicare Part A
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
Medicare Part B
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
POS
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
PPO
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield
Workers Comp
O
161.86
6.47
52.18
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
EPO
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
HMO
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
Medicaid
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
POS
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
PPO
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
161.86
6.47
52.17
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
EPO
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
HMO
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
Medicaid
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
Medicare Part A
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
Medicare Part B
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
POS
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
PPO
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
healthchoice
Workers Comp
O
161.86
6.47
6.47
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
EPO
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
HMO
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
Medicaid
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
Medicare Part A
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
Medicare Part B
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
POS
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
PPO
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
tricare
Workers Comp
O
161.86
6.47
52.20
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
EPO
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
HMO
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
Medicaid
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
Medicare Part A
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
Medicare Part B
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
POS
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
PPO
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
united healthcare
Workers Comp
O
161.86
6.47
121.40
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
EPO
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
HMO
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
Medicaid
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
Medicare Part A
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
Medicare Part B
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
POS
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
PPO
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99212
null
cpt
Established patient office or other outpatient visit typically 10 minutes
webtpa
Workers Comp
O
161.86
6.47
62.51
121.40
97.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
EPO
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
HMO
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
Medicaid
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
Medicare Part A
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
Medicare Part B
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
POS
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
PPO
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
aetna
Workers Comp
O
242.74
4.88
51.68
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
EPO
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
HMO
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
Medicaid
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
Medicare Part A
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
Medicare Part B
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
POS
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
PPO
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield
Workers Comp
O
242.74
4.88
62.05
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
EPO
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
HMO
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
Medicaid
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
POS
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
PPO
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
242.74
4.88
70.26
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
EPO
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
HMO
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
Medicaid
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
Medicare Part A
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
Medicare Part B
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
POS
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
PPO
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
geha
Workers Comp
O
242.74
4.88
182.06
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
EPO
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
HMO
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
Medicaid
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
Medicare Part A
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
Medicare Part B
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
POS
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
PPO
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
healthchoice
Workers Comp
O
242.74
4.88
4.88
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
EPO
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
HMO
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
Medicaid
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
Medicare Part A
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
Medicare Part B
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
POS
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
PPO
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
tricare
Workers Comp
O
242.74
4.88
79.85
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
EPO
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
HMO
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
Medicaid
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
Medicare Part A
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
Medicare Part B
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
POS
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
PPO
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare
Workers Comp
O
242.74
4.88
186.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
EPO
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
HMO
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
Medicaid
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
Medicare Part A
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
Medicare Part B
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
POS
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
PPO
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
united healthcare - medicare advantage
Workers Comp
O
242.74
4.88
85.61
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
EPO
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
HMO
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
Medicaid
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
Medicare Part A
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
Medicare Part B
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
POS
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
PPO
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
va
Workers Comp
O
242.74
4.88
50.21
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
EPO
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
HMO
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
Medicaid
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
Medicare Part A
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
Medicare Part B
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
POS
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
PPO
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99213
null
cpt
Established patient office or other outpatient visit typically 15 minutes
webtpa
Workers Comp
O
242.74
4.88
177.71
186.61
145.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
EPO
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
HMO
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
Medicaid
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
Medicare Part A
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
Medicare Part B
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
POS
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
PPO
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
aetna
Workers Comp
O
403.43
61.56
255.94
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
EPO
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
HMO
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
Medicaid
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
Medicare Part A
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
Medicare Part B
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
POS
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
PPO
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield
Workers Comp
O
403.43
61.56
61.56
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
EPO
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
HMO
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
Medicaid
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
POS
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
PPO
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
403.43
61.56
89.22
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
EPO
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
HMO
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
Medicaid
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
Medicare Part A
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
Medicare Part B
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
POS
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
PPO
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
healthchoice
Workers Comp
O
403.43
61.56
314.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
EPO
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
HMO
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
Medicaid
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
Medicare Part A
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
Medicare Part B
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
POS
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
PPO
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare
Workers Comp
O
403.43
61.56
302.57
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
EPO
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
HMO
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
Medicaid
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
Medicare Part A
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
Medicare Part B
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
POS
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
PPO
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
united healthcare - medicare advantage
Workers Comp
O
403.43
61.56
93.84
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
EPO
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
HMO
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
Medicaid
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
Medicare Part A
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
Medicare Part B
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
POS
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
PPO
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99214
null
cpt
Established patient office or other outpatient visit typically 25 minutes
va
Workers Comp
O
403.43
61.56
403.43
403.43
242.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
EPO
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
HMO
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
Medicaid
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
Medicare Part A
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
Medicare Part B
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
POS
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
PPO
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
aetna
Workers Comp
O
483.14
29.73
285.05
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
EPO
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
HMO
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
Medicaid
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
Medicare Part A
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
Medicare Part B
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
POS
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
PPO
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield
Workers Comp
O
483.14
29.73
219.42
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
EPO
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
HMO
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
Medicaid
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
Medicare Part A
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
Medicare Part B
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
POS
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
PPO
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
blue cross blue shield - medicare advantage
Workers Comp
O
483.14
29.73
29.73
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
EPO
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
HMO
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
Medicaid
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
Medicare Part A
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
Medicare Part B
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
POS
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
PPO
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99215
null
cpt
Established patient office or other outpatient visit typically 40 minutes
united healthcare
Workers Comp
O
483.14
29.73
362.36
362.36
289.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
EPO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
HMO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
Medicaid
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
Medicare Part A
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
Medicare Part B
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
POS
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
PPO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield
Workers Comp
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
EPO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
HMO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
Medicaid
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
Medicare Part A
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
Medicare Part B
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
POS
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
PPO
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
blue cross blue shield - medicare advantage
Workers Comp
E
183.64
61.67
183.64
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
EPO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
HMO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
Medicaid
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
Medicare Part A
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
Medicare Part B
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
POS
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
PPO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
humana - medicare advantage
Workers Comp
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
EPO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
HMO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
Medicaid
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
Medicare Part A
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
Medicare Part B
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
POS
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
PPO
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
tricare
Workers Comp
E
183.64
61.67
61.67
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
EPO
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
HMO
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
Medicaid
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
Medicare Part A
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
Medicare Part B
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
POS
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
PPO
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99281
null
cpt
Emergency department visit self limited or minor problem
united healthcare
Workers Comp
E
183.64
61.67
137.73
183.64
110.18


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
EPO
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
HMO
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
Medicaid
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
Medicare Part A
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
Medicare Part B
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
POS
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
PPO
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
aetna
Workers Comp
E
260.44
113.36
146.34
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
EPO
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
HMO
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
Medicaid
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
Medicare Part A
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
Medicare Part B
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
POS
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
PPO
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield
Workers Comp
E
260.44
113.36
260.44
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
EPO
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
HMO
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
Medicaid
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
Medicare Part A
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
Medicare Part B
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
POS
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
PPO
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
blue cross blue shield - medicare advantage
Workers Comp
E
260.44
113.36
248.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
EPO
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
HMO
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
Medicaid
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
Medicare Part A
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
Medicare Part B
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
POS
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
PPO
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
cigna
Workers Comp
E
260.44
113.36
184.29
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
EPO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
HMO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
Medicaid
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
Medicare Part A
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
Medicare Part B
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
POS
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
PPO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
humana - medicare advantage
Workers Comp
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
EPO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
HMO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
Medicaid
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
Medicare Part A
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
Medicare Part B
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
POS
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
PPO
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
tricare
Workers Comp
E
260.44
113.36
113.36
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
EPO
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
HMO
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
Medicaid
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
Medicare Part A
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
Medicare Part B
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
POS
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
PPO
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
united healthcare
Workers Comp
E
260.44
113.36
186.03
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
EPO
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
HMO
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
Medicaid
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
Medicare Part A
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
Medicare Part B
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
POS
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
PPO
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
va
Workers Comp
E
260.44
113.36
116.54
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
EPO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
HMO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
Medicaid
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
Medicare Part A
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
Medicare Part B
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
POS
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
PPO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
webtpa
Workers Comp
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
EPO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
HMO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
Medicaid
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
Medicare Part A
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
Medicare Part B
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
POS
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
PPO
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99282
null
cpt
Emergency department visit low to moderately severe problem
worker comp
Workers Comp
E
260.44
113.36
173.63
260.44
156.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
EPO
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
HMO
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
Medicaid
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
Medicare Part A
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
Medicare Part B
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
POS
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
PPO
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna
Workers Comp
E
450.76
166.78
253.29
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
EPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
HMO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
Medicaid
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
Medicare Part A
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
Medicare Part B
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
POS
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
PPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
aetna - medicare advantage
Workers Comp
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
EPO
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
HMO
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
Medicaid
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
Medicare Part A
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
Medicare Part B
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
POS
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
PPO
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield
Workers Comp
E
450.76
166.78
266.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
EPO
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
HMO
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
Medicaid
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
Medicare Part A
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
Medicare Part B
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
POS
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
PPO
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
blue cross blue shield - medicare advantage
Workers Comp
E
450.76
166.78
255.33
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
EPO
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
HMO
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
Medicaid
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
Medicare Part A
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
Medicare Part B
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
POS
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
PPO
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
cigna
Workers Comp
E
450.76
166.78
300.94
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
EPO
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
HMO
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
Medicaid
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
Medicare Part A
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
Medicare Part B
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
POS
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
PPO
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
geha
Workers Comp
E
450.76
166.78
338.08
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
EPO
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
HMO
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
Medicaid
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
Medicare Part A
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
Medicare Part B
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
POS
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
PPO
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
healthchoice
Workers Comp
E
450.76
166.78
199.68
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
EPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
HMO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
Medicaid
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
Medicare Part A
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
Medicare Part B
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
POS
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
PPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
humana - medicare advantage
Workers Comp
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
EPO
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
HMO
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
Medicaid
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
Medicare Part A
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
Medicare Part B
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
POS
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
PPO
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
medica
Workers Comp
E
450.76
166.78
166.78
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
EPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
HMO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
Medicaid
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
Medicare Part A
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
Medicare Part B
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
POS
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
PPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
tricare
Workers Comp
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
EPO
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
HMO
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
Medicaid
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
Medicare Part A
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
Medicare Part B
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
POS
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
PPO
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare
Workers Comp
E
450.76
166.78
321.98
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
EPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
HMO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
Medicaid
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
Medicare Part A
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
Medicare Part B
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
POS
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
PPO
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
united healthcare - medicare advantage
Workers Comp
E
450.76
166.78
197.85
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
EPO
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
HMO
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
Medicaid
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
Medicare Part A
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
Medicare Part B
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
POS
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
PPO
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
va
Workers Comp
E
450.76
166.78
205.11
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
EPO
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
HMO
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
Medicaid
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
Medicare Part A
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
Medicare Part B
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
POS
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
PPO
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
webtpa
Workers Comp
E
450.76
166.78
219.51
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
EPO
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
HMO
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
Medicaid
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
Medicare Part A
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
Medicare Part B
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
POS
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
PPO
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99283
null
cpt
Emergency department visit moderately severe problem
worker comp
Workers Comp
E
450.76
166.78
264.35
338.08
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
EPO
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
HMO
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
Medicaid
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
Medicare Part A
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
Medicare Part B
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
POS
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
PPO
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna
Workers Comp
E
891.51
257.77
509.02
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
EPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
HMO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
Medicaid
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
Medicare Part A
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
Medicare Part B
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
POS
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
PPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
aetna - medicare advantage
Workers Comp
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
EPO
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
HMO
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
Medicaid
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
Medicare Part A
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
Medicare Part B
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
POS
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
PPO
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield
Workers Comp
E
891.51
257.77
285.96
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
EPO
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
HMO
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
Medicaid
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
Medicare Part A
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
Medicare Part B
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
POS
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
PPO
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
blue cross blue shield - medicare advantage
Workers Comp
E
891.51
257.77
274.99
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
EPO
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
HMO
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
Medicaid
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
Medicare Part A
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
Medicare Part B
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
POS
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
PPO
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
cigna
Workers Comp
E
891.51
257.77
630.85
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
EPO
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
HMO
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
Medicaid
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
Medicare Part A
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
Medicare Part B
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
POS
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
PPO
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
healthchoice
Workers Comp
E
891.51
257.77
257.77
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
EPO
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
HMO
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
Medicaid
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
Medicare Part A
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
Medicare Part B
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
POS
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
PPO
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana
Workers Comp
E
891.51
257.77
321.98
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
EPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
HMO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
Medicaid
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
Medicare Part A
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
Medicare Part B
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
POS
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
PPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
humana - medicare advantage
Workers Comp
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
EPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
HMO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
Medicaid
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
Medicare Part A
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
Medicare Part B
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
POS
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
PPO
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
tricare
Workers Comp
E
891.51
257.77
311.64
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
EPO
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
HMO
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
Medicaid
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
Medicare Part A
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
Medicare Part B
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
POS
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
PPO
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare
Workers Comp
E
891.51
257.77
636.80
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
EPO
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
HMO
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
Medicaid
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
Medicare Part A
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
Medicare Part B
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
POS
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
PPO
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
united healthcare - medicare advantage
Workers Comp
E
891.51
257.77
305.41
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
EPO
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
HMO
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
Medicaid
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
Medicare Part A
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
Medicare Part B
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
POS
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
PPO
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
va
Workers Comp
E
891.51
257.77
322.13
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
EPO
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
HMO
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
Medicaid
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
Medicare Part A
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
Medicare Part B
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
POS
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
PPO
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
webtpa
Workers Comp
E
891.51
257.77
609.20
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
EPO
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
HMO
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
Medicaid
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
Medicare Part A
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
Medicare Part B
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
POS
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
PPO
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99284
null
cpt
Emergency department visit problem of high severity
worker comp
Workers Comp
E
891.51
257.77
282.37
636.80
534.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
EPO
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
HMO
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
Medicaid
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
Medicare Part A
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
Medicare Part B
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
POS
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
PPO
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna
Workers Comp
E
1397.92
90.00
785.50
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
EPO
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
HMO
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
Medicaid
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
Medicare Part A
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
Medicare Part B
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
POS
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
PPO
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
aetna - medicare advantage
Workers Comp
E
1397.92
90.00
446.94
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
EPO
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
HMO
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
Medicaid
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
Medicare Part A
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
Medicare Part B
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
POS
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
PPO
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield
Workers Comp
E
1397.92
90.00
329.65
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
EPO
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
HMO
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
Medicaid
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
Medicare Part A
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
Medicare Part B
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
POS
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
PPO
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
blue cross blue shield - medicare advantage
Workers Comp
E
1397.92
90.00
318.81
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
EPO
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
HMO
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
Medicaid
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
Medicare Part A
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
Medicare Part B
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
POS
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
PPO
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
cigna
Workers Comp
E
1397.92
90.00
933.28
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
EPO
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
HMO
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
Medicaid
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
Medicare Part A
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
Medicare Part B
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
POS
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
PPO
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
humana - medicare advantage
Workers Comp
E
1397.92
90.00
322.14
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
EPO
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
HMO
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
Medicaid
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
Medicare Part A
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
Medicare Part B
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
POS
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
PPO
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
tricare
Workers Comp
E
1397.92
90.00
453.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
EPO
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
HMO
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
Medicaid
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
Medicare Part A
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
Medicare Part B
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
POS
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
PPO
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare
Workers Comp
E
1397.92
90.00
998.52
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
EPO
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
HMO
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
Medicaid
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
Medicare Part A
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
Medicare Part B
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
POS
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
PPO
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
united healthcare - medicare advantage
Workers Comp
E
1397.92
90.00
90.00
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
EPO
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
HMO
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
Medicaid
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
Medicare Part A
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
Medicare Part B
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
POS
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
PPO
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
va
Workers Comp
E
1397.92
90.00
462.39
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
EPO
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
HMO
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
Medicaid
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
Medicare Part A
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
Medicare Part B
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
POS
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
PPO
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99285
null
cpt
Emergency department visit problem with significant threat to life or function
worker comp
Workers Comp
E
1397.92
90.00
212.90
998.52
838.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
EPO
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
HMO
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
Medicaid
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
Medicare Part A
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
Medicare Part B
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
POS
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
PPO
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
aetna
Workers Comp
O
1534.82
590.58
862.43
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
EPO
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
HMO
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
Medicaid
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
Medicare Part A
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
Medicare Part B
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
POS
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
PPO
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
humana - medicare advantage
Workers Comp
O
1534.82
590.58
929.40
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
EPO
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
HMO
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
Medicaid
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
Medicare Part A
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
Medicare Part B
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
POS
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
PPO
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
tricare
Workers Comp
O
1534.82
590.58
590.58
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
EPO
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
HMO
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
Medicaid
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
Medicare Part A
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
Medicare Part B
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
POS
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
PPO
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
united healthcare
Workers Comp
O
1534.82
590.58
1151.12
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
EPO
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
HMO
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
Medicaid
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
Medicare Part A
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
Medicare Part B
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
POS
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
PPO
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99291
null
cpt
Critical care delivery critically ill or injured patient first 30-74 minutes
va
Workers Comp
O
1534.82
590.58
613.44
1151.12
708.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
EPO
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
HMO
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
Medicaid
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
Medicare Part A
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
Medicare Part B
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
POS
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
PPO
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
aetna
Workers Comp
O
834.59
430.97
645.78
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
EPO
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
HMO
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
Medicaid
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
Medicare Part A
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
Medicare Part B
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
POS
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
PPO
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99292
null
cpt
Critical care delivery critically ill or injured patient
united healthcare
Workers Comp
O
834.59
430.97
430.97
645.78
500.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
EPO
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
HMO
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
Medicaid
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
Medicare Part A
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
Medicare Part B
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
POS
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
PPO
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
99401
null
cpt
Preventive medicine counseling approximately 15 minutes
tricare
Workers Comp
O
155.82
24.64
24.64
24.64
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
EPO
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
HMO
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
Medicaid
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
Medicare Part A
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
Medicare Part B
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
POS
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
PPO
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
cigna
Workers Comp
O
89.04
7.50
16.54
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
EPO
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
HMO
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
Medicaid
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
Medicare Part A
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
Medicare Part B
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
POS
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
PPO
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
humana - medicare advantage
Workers Comp
O
89.04
7.50
7.50
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
EPO
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
HMO
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
Medicaid
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
Medicare Part A
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
Medicare Part B
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
POS
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
PPO
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
tricare
Workers Comp
O
89.04
7.50
7.62
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
EPO
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
HMO
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
Medicaid
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
Medicare Part A
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
Medicare Part B
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
POS
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
PPO
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
united healthcare
Workers Comp
O
89.04
7.50
16.70
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
EPO
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
HMO
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
Medicaid
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
Medicare Part A
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
Medicare Part B
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
POS
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
PPO
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0425
null
cpt
ground mileage
va
Workers Comp
O
89.04
7.50
14.94
16.70
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
EPO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
HMO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
Medicaid
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
Medicare Part A
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
Medicare Part B
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
POS
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
PPO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
tricare
Workers Comp
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
EPO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
HMO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
Medicaid
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
Medicare Part A
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
Medicare Part B
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
POS
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
PPO
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
va
Workers Comp
O
814.08
261.28
261.28
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
EPO
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
HMO
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
Medicaid
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
Medicare Part A
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
Medicare Part B
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
POS
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
PPO
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0426
null
cpt
als 1
webtpa
Workers Comp
O
814.08
261.28
2018.99
2018.99
488.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
EPO
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
HMO
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
Medicaid
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
Medicare Part A
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
Medicare Part B
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
POS
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
PPO
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
cigna
Workers Comp
O
1357.86
407.08
1008.89
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
EPO
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
HMO
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
Medicaid
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
Medicare Part A
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
Medicare Part B
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
POS
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
PPO
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
humana - medicare advantage
Workers Comp
O
1357.86
407.08
407.08
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
EPO
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
HMO
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
Medicaid
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
Medicare Part A
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
Medicare Part B
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
POS
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
PPO
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
tricare
Workers Comp
O
1357.86
407.08
413.70
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
EPO
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
HMO
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
Medicaid
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
Medicare Part A
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
Medicare Part B
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
POS
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
PPO
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
united healthcare - medicare advantage
Workers Comp
O
1357.86
407.08
597.11
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
EPO
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
HMO
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
Medicaid
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
Medicare Part A
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
Medicare Part B
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
POS
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
PPO
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0427
null
cpt
als1-emergency
va
Workers Comp
O
1357.86
407.08
885.78
1008.89
814.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
EPO
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
HMO
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
Medicaid
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
Medicare Part A
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
Medicare Part B
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
POS
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
PPO
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
humana - medicare advantage
Workers Comp
O
590.42
213.83
213.83
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
EPO
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
HMO
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
Medicaid
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
Medicare Part A
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
Medicare Part B
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
POS
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
PPO
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
tricare
Workers Comp
O
590.42
213.83
217.74
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
EPO
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
HMO
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
Medicaid
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
Medicare Part A
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
Medicare Part B
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
POS
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
PPO
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0428
null
cpt
bls
united healthcare
Workers Comp
O
590.42
213.83
442.82
442.82
354.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
EPO
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
HMO
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
Medicaid
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
Medicare Part A
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
Medicare Part B
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
POS
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
PPO
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
humana - medicare advantage
Workers Comp
O
1033.50
341.04
346.71
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
EPO
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
HMO
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
Medicaid
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
Medicare Part A
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
Medicare Part B
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
POS
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
PPO
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
tricare
Workers Comp
O
1033.50
341.04
348.38
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
EPO
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
HMO
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
Medicaid
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
Medicare Part A
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
Medicare Part B
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
POS
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
PPO
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare
Workers Comp
O
1033.50
341.04
775.13
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
EPO
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
HMO
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
Medicaid
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
Medicare Part A
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
Medicare Part B
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
POS
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
PPO
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
united healthcare - medicare advantage
Workers Comp
O
1033.50
341.04
341.04
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
EPO
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
HMO
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
Medicaid
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
Medicare Part A
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
Medicare Part B
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
POS
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
PPO
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0429
null
cpt
bls-emergency
va
Workers Comp
O
1033.50
341.04
346.58
775.13
620.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
EPO
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
HMO
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
Medicaid
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
Medicare Part A
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
Medicare Part B
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
POS
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
PPO
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A0433
null
cpt
als 2
tricare
Workers Comp
O
1512.62
598.78
598.78
598.78
907.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
EPO
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
HMO
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
Medicaid
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
Medicare Part A
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
Medicare Part B
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
POS
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
PPO
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield
Workers Comp
O
20.13
6.53
6.85
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
EPO
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
HMO
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
Medicaid
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
Medicare Part A
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
Medicare Part B
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
POS
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
PPO
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
blue cross blue shield - medicare advantage
Workers Comp
O
20.13
6.53
6.53
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
EPO
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
HMO
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
Medicaid
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
Medicare Part A
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
Medicare Part B
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
POS
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
PPO
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
united healthcare
Workers Comp
O
20.13
6.53
14.39
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
EPO
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
HMO
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
Medicaid
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
Medicare Part A
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
Medicare Part B
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
POS
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
PPO
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4565
null
cpt
slings;; Medical and Surgical Supplies - Various Medical Supplies Including Tapes and Surgical Dressings
va
Workers Comp
O
20.13
6.53
8.94
14.39
12.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
EPO
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
HMO
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
Medicaid
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
Medicare Part A
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
Medicare Part B
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
POS
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
PPO
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4648
null
cpt
implantable tissue marker;; Medical and Surgical Supplies - Other Supplies
blue cross blue shield
Workers Comp
O
4340.70
1561.43
1561.43
1561.43
2604.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
EPO
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
HMO
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
Medicaid
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
Medicare Part A
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
Medicare Part B
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
POS
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
PPO
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A4649
null
cpt
surgical supplies;; Medical and Surgical Supplies - Other Supplies
va
Workers Comp
O
42.40
42.40
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
EPO
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
HMO
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicaid
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicare Part A
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicare Part B
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
POS
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
PPO
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Workers Comp
O
28.41
12.98
12.98
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
EPO
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
HMO
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicaid
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
POS
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
PPO
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6196
null
cpt
alginate dressing <=16 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
28.41
12.98
15.59
15.59
17.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
EPO
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
HMO
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicaid
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicare Part A
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Medicare Part B
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
POS
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
PPO
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield
Workers Comp
O
23.59
10.59
32.21
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
EPO
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
HMO
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicaid
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
POS
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
PPO
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6197
null
cpt
alginate drsg >16 <=48 sq in;; Medical and Surgical Supplies - Miscellaneous Dressing and Wound Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
23.59
10.59
10.59
32.21
14.15


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
EPO
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
HMO
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
Medicaid
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
Medicare Part A
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
Medicare Part B
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
POS
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
PPO
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6222
null
cpt
gauze <=16 in no w/sal w/o b;; Medical and Surgical Supplies - Gauze Dressings
blue cross blue shield - medicare advantage
Workers Comp
O
1.18
0.68
0.68
0.68
0.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
EPO
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
HMO
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicaid
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
POS
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
PPO
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6252
null
cpt
absorpt drg >16 <=48 w/o bdr;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
26.59
2.34
2.34
2.34
15.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
EPO
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
HMO
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicaid
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
POS
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
PPO
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A6253
null
cpt
absorpt drg > 48 sq in w/o b;; Medical and Surgical Supplies - Other Dressings Coverings and Wound Treatment Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
52.69
4.72
4.72
4.72
31.61


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
EPO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
HMO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
Medicaid
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
Medicare Part A
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
Medicare Part B
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
POS
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
PPO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna
Workers Comp
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
EPO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
HMO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
Medicaid
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
Medicare Part A
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
Medicare Part B
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
POS
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
PPO
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
aetna - medicare advantage
Workers Comp
O
653.33
114.25
367.11
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
EPO
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
HMO
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
Medicaid
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
Medicare Part A
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
Medicare Part B
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
POS
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
PPO
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield
Workers Comp
O
653.33
114.25
123.38
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
EPO
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
HMO
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
Medicaid
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
Medicare Part A
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
Medicare Part B
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
POS
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
PPO
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
blue cross blue shield - medicare advantage
Workers Comp
O
653.33
114.25
114.25
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
EPO
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
HMO
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
Medicaid
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
Medicare Part A
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
Medicare Part B
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
POS
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
PPO
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
united healthcare
Workers Comp
O
653.33
114.25
490.00
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
EPO
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
HMO
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
Medicaid
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
Medicare Part A
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
Medicare Part B
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
POS
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
PPO
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9500
null
cpt
tc99m sestamibi
va
Workers Comp
O
653.33
114.25
622.22
622.22
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
EPO
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
HMO
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
Medicaid
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
Medicare Part A
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
Medicare Part B
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
POS
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
PPO
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
aetna
Workers Comp
O
200.34
70.80
112.57
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
EPO
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
HMO
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
Medicaid
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
Medicare Part A
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
Medicare Part B
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
POS
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
PPO
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield
Workers Comp
O
200.34
70.80
129.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
EPO
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
HMO
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
Medicaid
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
Medicare Part A
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
Medicare Part B
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
POS
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
PPO
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
blue cross blue shield - medicare advantage
Workers Comp
O
200.34
70.80
70.80
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
EPO
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
HMO
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
Medicaid
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
Medicare Part A
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
Medicare Part B
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
POS
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
PPO
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9503
null
cpt
tc99m medronate
united healthcare
Workers Comp
O
200.34
70.80
143.10
143.10
120.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
EPO
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
HMO
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
Medicaid
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
Medicare Part A
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
Medicare Part B
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
POS
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
PPO
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
aetna
Workers Comp
O
130.38
76.92
76.92
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
EPO
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
HMO
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
Medicaid
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
Medicare Part A
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
Medicare Part B
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
POS
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
PPO
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9516
null
cpt
iodine i-123 sod iodide mic
blue cross blue shield
Workers Comp
O
130.38
76.92
89.30
89.30
78.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
EPO
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
HMO
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
Medicaid
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
Medicare Part A
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
Medicare Part B
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
POS
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
PPO
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9517
null
cpt
i131 iodide cap rx
blue cross blue shield - medicare advantage
Workers Comp
O
89.04
18.29
18.29
18.29
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
EPO
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
HMO
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
Medicaid
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
Medicare Part A
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
Medicare Part B
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
POS
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
PPO
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9520
null
cpt
tc99 tilmanocept diag 0.5mci
blue cross blue shield
Workers Comp
O
1756.68
683.07
683.07
683.07
1054.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
EPO
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
HMO
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
Medicaid
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
Medicare Part A
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
Medicare Part B
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
POS
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
PPO
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
aetna
Workers Comp
O
218.14
24.47
126.52
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
EPO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
HMO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
Medicaid
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
Medicare Part A
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
Medicare Part B
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
POS
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
PPO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield
Workers Comp
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
EPO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
HMO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
Medicaid
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
Medicare Part A
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
Medicare Part B
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
POS
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
PPO
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
blue cross blue shield - medicare advantage
Workers Comp
O
218.14
24.47
157.09
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
EPO
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
HMO
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
Medicaid
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
Medicare Part A
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
Medicare Part B
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
POS
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
PPO
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
united healthcare
Workers Comp
O
218.14
24.47
155.82
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
EPO
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
HMO
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
Medicaid
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
Medicare Part A
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
Medicare Part B
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
POS
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
PPO
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
va
Workers Comp
O
218.14
24.47
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
EPO
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
HMO
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
Medicaid
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
Medicare Part A
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
Medicare Part B
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
POS
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
PPO
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9537
null
cpt
tc99m mebrofenin
webtpa
Workers Comp
O
218.14
24.47
24.47
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
EPO
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
HMO
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
Medicaid
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
Medicare Part A
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
Medicare Part B
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
POS
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
PPO
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
blue cross blue shield
Workers Comp
O
195.57
85.63
85.63
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
EPO
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
HMO
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
Medicaid
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
Medicare Part A
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
Medicare Part B
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
POS
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
PPO
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9539
null
cpt
tc99m pentetate
united healthcare
Workers Comp
O
195.57
85.63
143.10
143.10
117.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
EPO
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
HMO
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
Medicaid
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
Medicare Part A
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
Medicare Part B
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
POS
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
PPO
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield
Workers Comp
O
218.14
86.89
86.89
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
EPO
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
HMO
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
Medicaid
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
Medicare Part A
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
Medicare Part B
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
POS
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
PPO
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
blue cross blue shield - medicare advantage
Workers Comp
O
218.14
86.89
121.59
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
EPO
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
HMO
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
Medicaid
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
Medicare Part A
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
Medicare Part B
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
POS
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
PPO
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9541
null
cpt
tc99m sulfur colloid
va
Workers Comp
O
218.14
86.89
207.76
207.76
130.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
EPO
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
HMO
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
Medicaid
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
Medicare Part A
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
Medicare Part B
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
POS
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
PPO
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
aetna
Workers Comp
O
1464.70
563.83
849.53
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
EPO
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
HMO
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
Medicaid
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
Medicare Part A
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
Medicare Part B
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
POS
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
PPO
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield
Workers Comp
O
1464.70
563.83
563.83
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
EPO
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
HMO
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
Medicaid
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
Medicare Part A
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
Medicare Part B
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
POS
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
PPO
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
blue cross blue shield - medicare advantage
Workers Comp
O
1464.70
563.83
573.72
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
EPO
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
HMO
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
Medicaid
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
Medicare Part A
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
Medicare Part B
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
POS
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
PPO
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
united healthcare
Workers Comp
O
1464.70
563.83
1046.23
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
EPO
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
HMO
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
Medicaid
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
Medicare Part A
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
Medicare Part B
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
POS
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
PPO
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9552
null
cpt
f18 fdg
worker comp
Workers Comp
O
1464.70
563.83
1046.22
1046.23
878.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
EPO
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
HMO
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
Medicaid
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
Medicare Part A
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
Medicare Part B
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
POS
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
PPO
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
aetna
Workers Comp
O
14.46
0.10
6.65
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
EPO
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
HMO
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
Medicaid
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
Medicare Part A
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
Medicare Part B
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
POS
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
PPO
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield
Workers Comp
O
14.46
0.10
4.60
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
EPO
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
HMO
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
Medicaid
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
Medicare Part A
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
Medicare Part B
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
POS
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
PPO
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
blue cross blue shield - medicare advantage
Workers Comp
O
14.46
0.10
3.68
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
EPO
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
HMO
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
Medicaid
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
Medicare Part A
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
Medicare Part B
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
POS
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
PPO
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
healthchoice
Workers Comp
O
14.46
0.10
0.10
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
EPO
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
HMO
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
Medicaid
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
Medicare Part A
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
Medicare Part B
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
POS
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
PPO
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
humana - medicare advantage
Workers Comp
O
14.46
0.10
6.47
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
EPO
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
HMO
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
Medicaid
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
Medicare Part A
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
Medicare Part B
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
POS
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
PPO
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
united healthcare
Workers Comp
O
14.46
0.10
10.34
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
EPO
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
HMO
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
Medicaid
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
Medicare Part A
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
Medicare Part B
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
POS
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
PPO
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9579
null
cpt
gad-base mr contrast nos1ml
va
Workers Comp
O
14.46
0.10
1.59
10.34
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
A9606
null
cpt
radium ra223 dichloride ther
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
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
EPO
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
HMO
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
Medicaid
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
Medicare Part A
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
Medicare Part B
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
POS
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
PPO
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield
Workers Comp
O
2860.60
949.09
949.09
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
EPO
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
HMO
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
Medicaid
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
Medicare Part A
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
Medicare Part B
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
POS
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
PPO
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
blue cross blue shield - medicare advantage
Workers Comp
O
2860.60
949.09
1331.22
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
EPO
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
HMO
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
Medicaid
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
Medicare Part A
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
Medicare Part B
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
POS
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
PPO
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
cigna
Workers Comp
O
2860.60
949.09
3019.83
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
EPO
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
HMO
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
Medicaid
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
Medicare Part A
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
Medicare Part B
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
POS
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
PPO
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1713
null
cpt
anchor/screw bn/bntis/bn
va
Workers Comp
O
2860.60
949.09
3296.59
3296.59
1716.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
EPO
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
HMO
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
Medicaid
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
Medicare Part A
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
Medicare Part B
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
POS
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
PPO
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1717
null
cpt
brachytx non-strhdr ir-192
united healthcare
Workers Comp
O
1041.98
781.49
781.49
781.49
625.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
EPO
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
HMO
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
Medicaid
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
Medicare Part A
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
Medicare Part B
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
POS
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
PPO
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
aetna
Workers Comp
O
56662.06
20895.86
20895.86
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
EPO
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
HMO
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
Medicaid
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
Medicare Part A
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
Medicare Part B
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
POS
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
PPO
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1722
null
cpt
aicd single chamber
blue cross blue shield
Workers Comp
O
56662.06
20895.86
23578.80
23578.80
33997.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
EPO
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
HMO
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
Medicaid
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
Medicare Part A
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
Medicare Part B
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
POS
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
PPO
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield
Workers Comp
O
1113.56
698.75
731.09
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
EPO
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
HMO
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
Medicaid
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
Medicare Part A
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
Medicare Part B
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
POS
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
PPO
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
blue cross blue shield - medicare advantage
Workers Comp
O
1113.56
698.75
698.75
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
EPO
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
HMO
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
Medicaid
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
Medicare Part A
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
Medicare Part B
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
POS
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
PPO
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1725
null
cpt
cath translumin non-laser
united healthcare
Workers Comp
O
1113.56
698.75
1117.73
1117.73
668.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
EPO
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
HMO
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
Medicaid
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
Medicare Part A
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
Medicare Part B
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
POS
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
PPO
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield
Workers Comp
O
225.93
132.23
165.76
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
EPO
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
HMO
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
Medicaid
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
Medicare Part A
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
Medicare Part B
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
POS
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
PPO
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
blue cross blue shield - medicare advantage
Workers Comp
O
225.93
132.23
132.23
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
EPO
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
HMO
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
Medicaid
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
Medicare Part A
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
Medicare Part B
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
POS
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
PPO
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1726
null
cpt
cath bal dil non-vascular
humana - medicare advantage
Workers Comp
O
225.93
132.23
225.93
225.93
135.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
EPO
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
HMO
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
Medicaid
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
Medicare Part A
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
Medicare Part B
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
POS
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
PPO
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1729
null
cpt
cath drainage
blue cross blue shield - medicare advantage
Workers Comp
O
807.48
244.14
244.14
244.14
484.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
EPO
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
HMO
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
Medicaid
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
Medicare Part A
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
Medicare Part B
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
POS
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
PPO
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield
Workers Comp
O
1156.40
322.04
322.04
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
EPO
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
HMO
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
Medicaid
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
Medicare Part A
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
Medicare Part B
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
POS
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
PPO
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1750
null
cpt
cath hemodialysislong-term
blue cross blue shield - medicare advantage
Workers Comp
O
1156.40
322.04
333.29
333.29
693.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
EPO
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
HMO
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
Medicaid
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
Medicare Part A
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
Medicare Part B
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
POS
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
PPO
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield
Workers Comp
O
954.95
131.28
138.13
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
EPO
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
HMO
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
Medicaid
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
Medicare Part A
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
Medicare Part B
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
POS
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
PPO
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1751
null
cpt
cath inf per/cent/midline
blue cross blue shield - medicare advantage
Workers Comp
O
954.95
131.28
131.28
138.13
572.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
EPO
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
HMO
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
Medicaid
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
Medicare Part A
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
Medicare Part B
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
POS
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
PPO
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield
Workers Comp
O
75.68
16.82
31.80
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
EPO
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
HMO
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
Medicaid
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
Medicare Part A
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
Medicare Part B
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
POS
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
PPO
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1758
null
cpt
catheter ureteral
blue cross blue shield - medicare advantage
Workers Comp
O
75.68
16.82
16.82
31.80
45.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
EPO
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
HMO
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
Medicaid
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
Medicare Part A
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
Medicare Part B
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
POS
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
PPO
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1760
null
cpt
closure dev vasc
blue cross blue shield
Workers Comp
O
1266.59
126.93
126.93
126.93
759.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
EPO
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
HMO
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
Medicaid
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
Medicare Part A
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
Medicare Part B
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
POS
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
PPO
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
aetna
Workers Comp
O
4620.06
1628.02
1628.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
EPO
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
HMO
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
Medicaid
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
Medicare Part A
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
Medicare Part B
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
POS
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
PPO
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield
Workers Comp
O
4620.06
1628.02
1895.02
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
EPO
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
HMO
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
Medicaid
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
Medicare Part A
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
Medicare Part B
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
POS
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
PPO
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1763
null
cpt
conn tiss non-human
blue cross blue shield - medicare advantage
Workers Comp
O
4620.06
1628.02
2712.12
2712.12
2772.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
EPO
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
HMO
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
Medicaid
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
Medicare Part A
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
Medicare Part B
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
POS
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
PPO
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield
Workers Comp
O
167.52
37.00
2635.55
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
EPO
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
HMO
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
Medicaid
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
Medicare Part A
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
Medicare Part B
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
POS
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
PPO
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1768
null
cpt
graft vascular
blue cross blue shield - medicare advantage
Workers Comp
O
167.52
37.00
37.00
2635.55
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
EPO
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
HMO
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
Medicaid
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
Medicare Part A
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
Medicare Part B
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
POS
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
PPO
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield
Workers Comp
O
198.11
24.69
24.69
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
EPO
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
HMO
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
Medicaid
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
Medicare Part A
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
Medicare Part B
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
POS
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
PPO
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
blue cross blue shield - medicare advantage
Workers Comp
O
198.11
24.69
127.74
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
EPO
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
HMO
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
Medicaid
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
Medicare Part A
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
Medicare Part B
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
POS
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
PPO
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
humana - medicare advantage
Workers Comp
O
198.11
24.69
2584.14
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
EPO
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
HMO
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
Medicaid
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
Medicare Part A
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
Medicare Part B
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
POS
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
PPO
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1769
null
cpt
guide wire
united healthcare
Workers Comp
O
198.11
24.69
148.58
2584.14
118.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
EPO
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
HMO
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
Medicaid
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
Medicare Part A
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
Medicare Part B
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
POS
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
PPO
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield
Workers Comp
O
4746.94
719.74
2006.36
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
EPO
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
HMO
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
Medicaid
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
Medicare Part A
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
Medicare Part B
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
POS
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
PPO
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
blue cross blue shield - medicare advantage
Workers Comp
O
4746.94
719.74
1918.13
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
EPO
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
HMO
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
Medicaid
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
Medicare Part A
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
Medicare Part B
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
POS
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
PPO
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1776
null
cpt
joint device (implantable)
va
Workers Comp
O
4746.94
719.74
719.74
2006.36
2848.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
EPO
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
HMO
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
Medicaid
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
Medicare Part A
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
Medicare Part B
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
POS
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
PPO
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1777
null
cpt
lead aicd endo single coil
blue cross blue shield
Workers Comp
O
20449.52
8722.41
8722.41
8722.41
12269.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
EPO
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
HMO
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
Medicaid
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
Medicare Part A
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
Medicare Part B
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
POS
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
PPO
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield
Workers Comp
O
1806.20
483.80
586.11
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
EPO
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
HMO
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
Medicaid
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
Medicare Part A
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
Medicare Part B
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
POS
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
PPO
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1781
null
cpt
mesh (implantable)
blue cross blue shield - medicare advantage
Workers Comp
O
1806.20
483.80
483.80
586.11
1083.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
EPO
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
HMO
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
Medicaid
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
Medicare Part A
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
Medicare Part B
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
POS
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
PPO
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1785
null
cpt
pmkr dual rate-resp
blue cross blue shield
Workers Comp
O
16994.66
3930.69
3930.69
3930.69
10196.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
EPO
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
HMO
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
Medicaid
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
Medicare Part A
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
Medicare Part B
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
POS
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
PPO
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
aetna
Workers Comp
O
1545.95
357.32
544.77
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
EPO
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
HMO
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
Medicaid
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
Medicare Part A
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
Medicare Part B
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
POS
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
PPO
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield
Workers Comp
O
1545.95
357.32
501.43
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
EPO
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
HMO
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
Medicaid
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
Medicare Part A
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
Medicare Part B
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
POS
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
PPO
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1788
null
cpt
port indwelling imp
blue cross blue shield - medicare advantage
Workers Comp
O
1545.95
357.32
357.32
544.77
927.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
EPO
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
HMO
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
Medicaid
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
Medicare Part A
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
Medicare Part B
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
POS
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
PPO
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1819
null
cpt
tissue localization-excision
blue cross blue shield
Workers Comp
O
158.54
65.78
65.78
65.78
95.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
EPO
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
HMO
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
Medicaid
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
Medicare Part A
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
Medicare Part B
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
POS
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
PPO
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield
Workers Comp
O
5841.14
611.89
2248.01
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
EPO
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
HMO
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
Medicaid
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
Medicare Part A
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
Medicare Part B
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
POS
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
PPO
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1874
null
cpt
stent coated/cov w/del sys
blue cross blue shield - medicare advantage
Workers Comp
O
5841.14
611.89
611.89
2248.01
3504.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
EPO
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
HMO
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
Medicaid
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
Medicare Part A
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
Medicare Part B
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
POS
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
PPO
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1875
null
cpt
stent coated/cov w/o del sy
va
Workers Comp
O
26301.60
2724.44
2724.44
2724.44
15780.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
EPO
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
HMO
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
Medicaid
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
Medicare Part A
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
Medicare Part B
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
POS
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
PPO
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1876
null
cpt
stent non-coa/non-cov w/del
blue cross blue shield
Workers Comp
O
821.39
348.78
348.78
348.78
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
EPO
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
HMO
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
Medicaid
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
Medicare Part A
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
Medicare Part B
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
POS
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
PPO
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1882
null
cpt
aicd other than sing/dual
blue cross blue shield
Workers Comp
O
79949.01
54355.89
54355.89
54355.89
47969.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
EPO
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
HMO
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
Medicaid
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
Medicare Part A
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
Medicare Part B
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
POS
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
PPO
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield
Workers Comp
O
28.93
13.78
16.29
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
EPO
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
HMO
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
Medicaid
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
Medicare Part A
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
Medicare Part B
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
POS
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
PPO
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1884
null
cpt
embolization protect syst
blue cross blue shield - medicare advantage
Workers Comp
O
28.93
13.78
13.78
16.29
17.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
EPO
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
HMO
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
Medicaid
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
Medicare Part A
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
Medicare Part B
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
POS
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
PPO
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1886
null
cpt
catheter ablation
blue cross blue shield
Workers Comp
O
4105.85
1078.04
1078.04
1078.04
2463.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
EPO
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
HMO
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
Medicaid
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
Medicare Part A
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
Medicare Part B
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
POS
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
PPO
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield
Workers Comp
O
989.82
117.23
117.23
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
EPO
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
HMO
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
Medicaid
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
Medicare Part A
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
Medicare Part B
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
POS
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
PPO
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1887
null
cpt
catheter guiding
blue cross blue shield - medicare advantage
Workers Comp
O
989.82
117.23
209.00
209.00
593.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
EPO
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
HMO
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
Medicaid
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
Medicare Part A
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
Medicare Part B
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
POS
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
PPO
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1892
null
cpt
intro/sheathfixedpeel-away
blue cross blue shield
Workers Comp
O
547.04
121.33
121.33
121.33
328.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
EPO
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
HMO
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
Medicaid
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
Medicare Part A
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
Medicare Part B
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
POS
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
PPO
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield
Workers Comp
O
407.04
54.53
54.53
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
EPO
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
HMO
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
Medicaid
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
Medicare Part A
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
Medicare Part B
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
POS
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
PPO
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
blue cross blue shield - medicare advantage
Workers Comp
O
407.04
54.53
62.99
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
EPO
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
HMO
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
Medicaid
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
Medicare Part A
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
Medicare Part B
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
POS
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
PPO
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C1894
null
cpt
intro/sheath non-laser
united healthcare
Workers Comp
O
407.04
54.53
255.73
255.73
244.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
EPO
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
HMO
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
Medicaid
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
Medicare Part A
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
Medicare Part B
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
POS
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
PPO
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield
Workers Comp
O
821.39
233.35
388.27
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
EPO
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
HMO
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
Medicaid
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
Medicare Part A
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
Medicare Part B
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
POS
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
PPO
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2617
null
cpt
stent non-cor tem w/o del
blue cross blue shield - medicare advantage
Workers Comp
O
821.39
233.35
233.35
388.27
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
EPO
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
HMO
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
Medicaid
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
Medicare Part A
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
Medicare Part B
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
POS
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
PPO
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield
Workers Comp
O
360.61
105.39
139.16
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
EPO
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
HMO
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
Medicaid
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
Medicare Part A
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
Medicare Part B
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
POS
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
PPO
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2628
null
cpt
catheter occlusion
blue cross blue shield - medicare advantage
Workers Comp
O
360.61
105.39
105.39
139.16
216.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
EPO
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
HMO
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
Medicaid
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
Medicare Part A
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
Medicare Part B
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
POS
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
PPO
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C2629
null
cpt
intro/sheath laser
blue cross blue shield
Workers Comp
O
593.22
240.42
240.42
240.42
355.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
EPO
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
HMO
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
Medicaid
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
Medicare Part A
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
Medicare Part B
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
POS
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
PPO
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
aetna
Workers Comp
O
2840.37
326.02
1647.41
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
EPO
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
HMO
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
Medicaid
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
Medicare Part A
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
Medicare Part B
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
POS
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
PPO
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield
Workers Comp
O
2840.37
326.02
924.25
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
EPO
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
HMO
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
Medicaid
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
Medicare Part A
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
Medicare Part B
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
POS
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
PPO
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
blue cross blue shield - medicare advantage
Workers Comp
O
2840.37
326.02
1300.08
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
EPO
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
HMO
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
Medicaid
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
Medicare Part A
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
Medicare Part B
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
POS
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
PPO
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
humana - medicare advantage
Workers Comp
O
2840.37
326.02
326.02
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
EPO
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
HMO
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
Medicaid
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
Medicare Part A
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
Medicare Part B
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
POS
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
PPO
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
tricare
Workers Comp
O
2840.37
326.02
338.27
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
EPO
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
HMO
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
Medicaid
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
Medicare Part A
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
Medicare Part B
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
POS
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
PPO
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
united healthcare
Workers Comp
O
2840.37
326.02
2028.84
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
EPO
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
HMO
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
Medicaid
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
Medicare Part A
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
Medicare Part B
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
POS
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
PPO
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C8908
null
cpt
mri w/o fol w/cont breast
va
Workers Comp
O
2840.37
326.02
2705.12
2705.12
1704.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
EPO
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
HMO
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
Medicaid
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
Medicare Part A
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
Medicare Part B
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
POS
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
PPO
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9399
null
cpt
unclassified drugs or biolog
united healthcare
Workers Comp
O
26703.00
51.75
51.75
51.75
16021.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
EPO
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
EPO
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
HMO
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
HMO
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicaid
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicaid
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicare Part A
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicare Part A
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicare Part B
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Medicare Part B
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
POS
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
POS
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
PPO
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
PPO
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Workers Comp
I
67846.55
42815.71
42815.71
42815.71
40707.93


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
aetna
Workers Comp
O
65312.85
8777.72
14191.44
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
EPO
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
HMO
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
Medicaid
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
Medicare Part A
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
Medicare Part B
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
POS
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
PPO
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
blue cross blue shield
Workers Comp
O
65312.85
8777.72
26459.88
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
EPO
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
HMO
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
Medicaid
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
Medicare Part A
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
Medicare Part B
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
POS
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
PPO
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
humana - medicare advantage
Workers Comp
O
65312.85
8777.72
8777.72
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
EPO
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
HMO
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
Medicaid
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
Medicare Part A
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
Medicare Part B
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
POS
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
PPO
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
tricare
Workers Comp
O
65312.85
8777.72
11449.31
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
EPO
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
HMO
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
Medicaid
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
Medicare Part A
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
Medicare Part B
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
POS
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
PPO
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9600
null
cpt
perc drug-el cor stent sing
va
Workers Comp
O
65312.85
8777.72
8894.13
26459.88
39187.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
EPO
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
HMO
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
Medicaid
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
Medicare Part A
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
Medicare Part B
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
POS
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
PPO
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9601
null
cpt
perc drug-el cor stent bran
aetna
Workers Comp
O
95713.44
14191.44
14191.44
14191.44
57428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
EPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
HMO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
Medicaid
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
Medicare Part A
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
Medicare Part B
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
POS
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
PPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
aetna - medicare advantage
Workers Comp
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
EPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
HMO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
Medicaid
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
Medicare Part A
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
Medicare Part B
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
POS
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
PPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
humana - medicare advantage
Workers Comp
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
EPO
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
HMO
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
Medicaid
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
Medicare Part A
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
Medicare Part B
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
POS
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
PPO
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
tricare
Workers Comp
O
88012.50
14120.90
14226.92
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
EPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
HMO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
Medicaid
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
Medicare Part A
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
Medicare Part B
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
POS
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
PPO
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9602
null
cpt
perc d-e cor stent ather s
va
Workers Comp
O
88012.50
14120.90
14120.90
14226.92
52807.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
EPO
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
HMO
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
Medicaid
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
Medicare Part A
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
Medicare Part B
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
POS
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
PPO
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
humana - medicare advantage
Workers Comp
O
52922.87
8742.65
8777.72
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
EPO
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
HMO
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
Medicaid
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
Medicare Part A
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
Medicare Part B
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
POS
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
PPO
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9604
null
cpt
perc d-e cor revasc t cabg s
va
Workers Comp
O
52922.87
8742.65
8742.65
8777.72
31753.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
EPO
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
HMO
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
Medicaid
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
Medicare Part A
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
Medicare Part B
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
POS
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
PPO
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
humana - medicare advantage
Workers Comp
O
68987.10
14120.90
14120.90
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
EPO
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
HMO
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
Medicaid
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
Medicare Part A
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
Medicare Part B
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
POS
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
PPO
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
C9607
null
cpt
perc d-e cor revasc chro sin
tricare
Workers Comp
O
68987.10
14120.90
14226.92
14226.92
41392.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
EPO
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
HMO
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
Medicaid
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
Medicare Part A
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
Medicare Part B
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
POS
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
PPO
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna
Workers Comp
O
93.49
13.38
33.76
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
EPO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
HMO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
Medicaid
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
Medicare Part A
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
Medicare Part B
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
POS
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
PPO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
aetna - medicare advantage
Workers Comp
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
EPO
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
HMO
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
Medicaid
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
Medicare Part A
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
Medicare Part B
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
POS
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
PPO
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield
Workers Comp
O
93.49
13.38
13.38
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
EPO
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
HMO
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
Medicaid
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
Medicare Part A
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
Medicare Part B
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
POS
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
PPO
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
blue cross blue shield - medicare advantage
Workers Comp
O
93.49
13.38
19.41
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
EPO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
HMO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
Medicaid
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
Medicare Part A
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
Medicare Part B
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
POS
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
PPO
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
humana - medicare advantage
Workers Comp
O
93.49
13.38
35.43
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
EPO
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
HMO
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
Medicaid
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
Medicare Part A
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
Medicare Part B
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
POS
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
PPO
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0008
null
cpt
admin influenza virus vac
tricare
Workers Comp
O
93.49
13.38
34.05
35.43
40.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
EPO
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
HMO
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
Medicaid
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
Medicare Part A
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
Medicare Part B
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
POS
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
PPO
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
humana - medicare advantage
Workers Comp
O
80.56
33.76
33.76
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
EPO
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
HMO
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
Medicaid
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
Medicare Part A
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
Medicare Part B
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
POS
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
PPO
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0009
null
cpt
admin pneumococcal vaccine
va
Workers Comp
O
80.56
33.76
35.42
35.42
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
EPO
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
HMO
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
Medicaid
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
Medicare Part A
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
Medicare Part B
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
POS
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
PPO
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna
Workers Comp
O
86.14
15.50
48.40
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
EPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
HMO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
Medicaid
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
Medicare Part A
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
Medicare Part B
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
POS
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
PPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
aetna - medicare advantage
Workers Comp
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
EPO
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
HMO
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
Medicaid
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
Medicare Part A
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
Medicare Part B
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
POS
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
PPO
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield
Workers Comp
O
86.14
15.50
15.50
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
EPO
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
HMO
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
Medicaid
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
Medicare Part A
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
Medicare Part B
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
POS
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
PPO
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
blue cross blue shield - medicare advantage
Workers Comp
O
86.14
15.50
15.67
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
EPO
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
HMO
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
Medicaid
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
Medicare Part A
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
Medicare Part B
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
POS
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
PPO
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
cigna
Workers Comp
O
86.14
15.50
57.51
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
EPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
HMO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
Medicaid
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
Medicare Part A
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
Medicare Part B
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
POS
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
PPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
humana - medicare advantage
Workers Comp
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
EPO
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
HMO
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
Medicaid
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
Medicare Part A
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
Medicare Part B
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
POS
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
PPO
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
tricare
Workers Comp
O
86.14
15.50
19.39
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
EPO
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
HMO
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
Medicaid
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
Medicare Part A
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
Medicare Part B
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
POS
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
PPO
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare
Workers Comp
O
86.14
15.50
61.53
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
EPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
HMO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
Medicaid
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
Medicare Part A
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
Medicare Part B
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
POS
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
PPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
united healthcare - medicare advantage
Workers Comp
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
EPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
HMO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
Medicaid
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
Medicare Part A
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
Medicare Part B
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
POS
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
PPO
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
va
Workers Comp
O
86.14
15.50
19.31
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
EPO
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
HMO
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
Medicaid
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
Medicare Part A
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
Medicare Part B
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
POS
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
PPO
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0103
null
cpt
psa screening
webtpa
Workers Comp
O
86.14
15.50
60.30
61.53
51.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
EPO
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
HMO
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
Medicaid
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
Medicare Part A
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
Medicare Part B
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
POS
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
PPO
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0104
null
cpt
ca screen;flexi sigmoidscope
va
Workers Comp
O
2858.04
1179.15
1179.15
1179.15
1714.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
EPO
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
HMO
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
Medicaid
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
Medicare Part A
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
Medicare Part B
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
POS
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
PPO
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield
Workers Comp
O
2990.09
676.71
1370.78
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
EPO
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
HMO
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
Medicaid
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
Medicare Part A
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
Medicare Part B
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
POS
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
PPO
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
blue cross blue shield - medicare advantage
Workers Comp
O
2990.09
676.71
1370.53
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
EPO
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
HMO
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
Medicaid
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
Medicare Part A
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
Medicare Part B
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
POS
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
PPO
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
humana - medicare advantage
Workers Comp
O
2990.09
676.71
702.89
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
EPO
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
HMO
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
Medicaid
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
Medicare Part A
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
Medicare Part B
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
POS
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
PPO
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
tricare
Workers Comp
O
2990.09
676.71
676.71
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
EPO
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
HMO
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
Medicaid
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
Medicare Part A
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
Medicare Part B
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
POS
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
PPO
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
united healthcare
Workers Comp
O
2990.09
676.71
2295.35
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
EPO
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
HMO
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
Medicaid
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
Medicare Part A
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
Medicare Part B
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
POS
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
PPO
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0105
null
cpt
colorectal scrn; hi risk ind
va
Workers Comp
O
2990.09
676.71
688.43
2295.35
1794.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
EPO
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
HMO
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
Medicaid
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
Medicare Part A
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
Medicare Part B
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
POS
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
PPO
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna
Workers Comp
O
2975.71
629.51
1623.13
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
EPO
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
HMO
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
Medicaid
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
Medicare Part A
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
Medicare Part B
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
POS
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
PPO
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
aetna - medicare advantage
Workers Comp
O
2975.71
629.51
629.51
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
EPO
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
HMO
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
Medicaid
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
Medicare Part A
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
Medicare Part B
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
POS
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
PPO
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield
Workers Comp
O
2975.71
629.51
1382.14
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
EPO
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
HMO
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
Medicaid
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
Medicare Part A
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
Medicare Part B
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
POS
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
PPO
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
blue cross blue shield - medicare advantage
Workers Comp
O
2975.71
629.51
1370.55
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
EPO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
HMO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
Medicaid
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
Medicare Part A
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
Medicare Part B
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
POS
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
PPO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
humana - medicare advantage
Workers Comp
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
EPO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
HMO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
Medicaid
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
Medicare Part A
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
Medicare Part B
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
POS
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
PPO
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
tricare
Workers Comp
O
2975.71
629.51
702.89
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
EPO
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
HMO
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
Medicaid
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
Medicare Part A
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
Medicare Part B
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
POS
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
PPO
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
united healthcare
Workers Comp
O
2975.71
629.51
2141.36
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
EPO
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
HMO
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
Medicaid
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
Medicare Part A
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
Medicare Part B
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
POS
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
PPO
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0121
null
cpt
colon ca scrn not hi rsk ind
va
Workers Comp
O
2975.71
629.51
702.86
2141.36
1785.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
EPO
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
HMO
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
Medicaid
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
Medicare Part A
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
Medicare Part B
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
POS
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
PPO
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
aetna
Workers Comp
O
1971.79
139.91
139.91
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
EPO
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
HMO
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
Medicaid
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
Medicare Part A
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
Medicare Part B
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
POS
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
PPO
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield
Workers Comp
O
1971.79
139.91
1060.41
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
EPO
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
HMO
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
Medicaid
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
Medicare Part A
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
Medicare Part B
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
POS
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
PPO
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
blue cross blue shield - medicare advantage
Workers Comp
O
1971.79
139.91
753.48
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
EPO
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
HMO
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
Medicaid
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
Medicare Part A
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
Medicare Part B
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
POS
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
PPO
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
humana - medicare advantage
Workers Comp
O
1971.79
139.91
553.72
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
EPO
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
HMO
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
Medicaid
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
Medicare Part A
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
Medicare Part B
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
POS
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
PPO
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
tricare
Workers Comp
O
1971.79
139.91
692.15
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
EPO
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
HMO
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
Medicaid
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
Medicare Part A
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
Medicare Part B
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
POS
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
PPO
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0260
null
cpt
inj for sacroiliac jt anesth
va
Workers Comp
O
1971.79
139.91
562.00
1060.41
1183.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
EPO
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
HMO
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
Medicaid
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
Medicare Part A
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
Medicare Part B
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
POS
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
PPO
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
aetna
Workers Comp
O
67504.00
4348.64
4348.64
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
EPO
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
HMO
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
Medicaid
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
Medicare Part A
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
Medicare Part B
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
POS
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
PPO
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
humana - medicare advantage
Workers Comp
O
67504.00
4348.64
8894.43
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
EPO
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
HMO
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
Medicaid
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
Medicare Part A
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
Medicare Part B
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
POS
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
PPO
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0269
null
cpt
occlusive device in vein art
tricare
Workers Comp
O
67504.00
4348.64
8777.72
8894.43
40502.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0277
null
cpt
hbot full body chamber 30m
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
G0279
null
cpt
tomosynthesis mammo
aetna
EPO
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
HMO
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
Medicaid
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
Medicare Part A
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
Medicare Part B
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
POS
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
PPO
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna
Workers Comp
O
113.52
22.38
65.84
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
EPO
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
HMO
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
Medicaid
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
Medicare Part A
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
Medicare Part B
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
POS
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
PPO
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
aetna - medicare advantage
Workers Comp
O
113.52
22.38
42.92
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
EPO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
HMO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
Medicaid
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
Medicare Part A
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
Medicare Part B
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
POS
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
PPO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield
Workers Comp
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
EPO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
HMO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
Medicaid
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
Medicare Part A
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
Medicare Part B
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
POS
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
PPO
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
blue cross blue shield - medicare advantage
Workers Comp
O
113.52
22.38
88.83
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
EPO
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
HMO
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
Medicaid
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
Medicare Part A
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
Medicare Part B
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
POS
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
PPO
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
humana - medicare advantage
Workers Comp
O
113.52
22.38
22.38
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
EPO
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
HMO
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
Medicaid
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
Medicare Part A
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
Medicare Part B
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
POS
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
PPO
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
tricare
Workers Comp
O
113.52
22.38
22.41
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
EPO
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
HMO
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
Medicaid
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
Medicare Part A
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
Medicare Part B
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
POS
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
PPO
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
united healthcare
Workers Comp
O
113.52
22.38
81.09
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
EPO
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
HMO
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
Medicaid
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
Medicare Part A
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
Medicare Part B
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
POS
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
PPO
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0279
null
cpt
tomosynthesis mammo
va
Workers Comp
O
113.52
22.38
52.11
88.83
68.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
EPO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
HMO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
Medicaid
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
Medicare Part A
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
Medicare Part B
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
POS
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
PPO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield
Workers Comp
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
EPO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
HMO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
Medicaid
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
Medicare Part A
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
Medicare Part B
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
POS
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
PPO
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
blue cross blue shield - medicare advantage
Workers Comp
O
87.92
9.47
87.92
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
EPO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
HMO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
Medicaid
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
Medicare Part A
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
Medicare Part B
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
POS
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
PPO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
humana - medicare advantage
Workers Comp
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
EPO
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
HMO
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
Medicaid
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
Medicare Part A
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
Medicare Part B
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
POS
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
PPO
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
tricare
Workers Comp
O
87.92
9.47
13.20
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
EPO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
HMO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
Medicaid
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
Medicare Part A
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
Medicare Part B
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
POS
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
PPO
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0283
null
cpt
elec stim other than wound
va
Workers Comp
O
87.92
9.47
9.47
87.92
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
EPO
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
HMO
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
Medicaid
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
Medicare Part A
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
Medicare Part B
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
POS
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
PPO
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
aetna - medicare advantage
Workers Comp
O
312.75
52.66
70.00
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
EPO
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
HMO
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
Medicaid
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
Medicare Part A
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
Medicare Part B
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
POS
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
PPO
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
blue cross blue shield
Workers Comp
O
312.75
52.66
305.31
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
EPO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
HMO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
Medicaid
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
Medicare Part A
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
Medicare Part B
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
POS
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
PPO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
humana - medicare advantage
Workers Comp
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
EPO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
HMO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
Medicaid
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
Medicare Part A
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
Medicare Part B
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
POS
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
PPO
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
tricare
Workers Comp
O
312.75
52.66
70.70
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
EPO
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
HMO
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
Medicaid
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
Medicare Part A
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
Medicare Part B
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
POS
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
PPO
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare
Workers Comp
O
312.75
52.66
228.98
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
EPO
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
HMO
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
Medicaid
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
Medicare Part A
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
Medicare Part B
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
POS
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
PPO
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
united healthcare - medicare advantage
Workers Comp
O
312.75
52.66
52.66
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
EPO
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
HMO
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
Medicaid
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
Medicare Part A
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
Medicare Part B
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
POS
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
PPO
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0297
null
cpt
ldct for lung ca screen
webtpa
Workers Comp
O
312.75
52.66
208.50
305.31
187.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
EPO
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
HMO
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
Medicaid
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
Medicare Part A
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
Medicare Part B
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
POS
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
PPO
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield
Workers Comp
O
171.35
11.77
20.58
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
EPO
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
HMO
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
Medicaid
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
Medicare Part A
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
Medicare Part B
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
POS
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
PPO
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
blue cross blue shield - medicare advantage
Workers Comp
O
171.35
11.77
37.38
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
EPO
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
HMO
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
Medicaid
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
Medicare Part A
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
Medicare Part B
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
POS
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
PPO
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0378
null
cpt
hospital observation per hr
united healthcare
Workers Comp
O
171.35
11.77
11.77
37.38
102.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
EPO
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
HMO
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
Medicaid
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
Medicare Part A
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
Medicare Part B
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
POS
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
PPO
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0382
null
cpt
lev 3 hosp type b ed visit
blue cross blue shield
Workers Comp
E
450.76
108.36
108.36
108.36
270.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
EPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
HMO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
Medicaid
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
Medicare Part A
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
Medicare Part B
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
POS
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
PPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna
Workers Comp
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
EPO
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
HMO
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
Medicaid
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
Medicare Part A
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
Medicare Part B
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
POS
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
PPO
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
aetna - medicare advantage
Workers Comp
O
167.48
52.19
102.66
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
EPO
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
HMO
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
Medicaid
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
Medicare Part A
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
Medicare Part B
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
POS
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
PPO
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield
Workers Comp
O
167.48
52.19
52.19
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
EPO
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
HMO
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
Medicaid
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
Medicare Part A
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
Medicare Part B
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
POS
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
PPO
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
blue cross blue shield - medicare advantage
Workers Comp
O
167.48
52.19
103.73
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
EPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
HMO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
Medicaid
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
Medicare Part A
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
Medicare Part B
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
POS
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
PPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
humana - medicare advantage
Workers Comp
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
EPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
HMO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
Medicaid
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
Medicare Part A
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
Medicare Part B
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
POS
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
PPO
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
tricare
Workers Comp
O
167.48
52.19
102.70
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
EPO
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
HMO
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
Medicaid
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
Medicare Part A
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
Medicare Part B
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
POS
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
PPO
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
united healthcare - medicare advantage
Workers Comp
O
167.48
52.19
100.65
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
EPO
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
HMO
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
Medicaid
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
Medicare Part A
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
Medicare Part B
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
POS
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
PPO
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0463
null
cpt
hospital outpt clinic visit
va
Workers Comp
O
167.48
52.19
105.16
105.16
100.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
EPO
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
HMO
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
Medicaid
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
Medicare Part A
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
Medicare Part B
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
POS
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
PPO
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0480
null
cpt
drug test def 1-7 classes
blue cross blue shield
Workers Comp
O
87.92
9.11
9.11
9.11
52.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
EPO
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
HMO
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
Medicaid
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
Medicare Part A
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
Medicare Part B
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
POS
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
PPO
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0481
null
cpt
drug test def 8-14 classes
aetna - medicare advantage
Workers Comp
O
315.99
156.59
156.59
156.59
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
EPO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
HMO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
Medicaid
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
Medicare Part A
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
Medicare Part B
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
POS
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
PPO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield
Workers Comp
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
EPO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
HMO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
Medicaid
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
Medicare Part A
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
Medicare Part B
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
POS
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
PPO
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
blue cross blue shield - medicare advantage
Workers Comp
O
315.99
85.00
85.00
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
EPO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
HMO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
Medicaid
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
Medicare Part A
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
Medicare Part B
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
POS
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
PPO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
humana - medicare advantage
Workers Comp
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
EPO
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
HMO
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
Medicaid
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
Medicare Part A
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
Medicare Part B
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
POS
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
PPO
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
tricare
Workers Comp
O
315.99
85.00
199.55
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
EPO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
HMO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
Medicaid
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
Medicare Part A
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
Medicare Part B
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
POS
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
PPO
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0482
null
cpt
drug test def 15-21 classes
va
Workers Comp
O
315.99
85.00
198.74
199.55
189.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
EPO
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
HMO
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
Medicaid
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
Medicare Part A
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
Medicare Part B
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
POS
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
PPO
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
aetna
Workers Comp
O
42.40
25.02
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
EPO
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
HMO
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
Medicaid
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
Medicare Part A
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
Medicare Part B
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
POS
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
PPO
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
cigna
Workers Comp
O
42.40
25.02
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
EPO
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
HMO
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
Medicaid
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
Medicare Part A
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
Medicare Part B
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
POS
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
PPO
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G0500
null
cpt
mod sedat endo service >5yrs
va
Workers Comp
O
42.40
25.02
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
EPO
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
HMO
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
Medicaid
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
Medicare Part A
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
Medicare Part B
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
POS
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
PPO
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
G2025
null
cpt
dis site tele svcs rhc/fqhc
aetna
Workers Comp
O
138.00
67.21
67.21
67.21
82.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
EPO
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
HMO
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
Medicaid
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
Medicare Part A
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
Medicare Part B
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
POS
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
PPO
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
aetna
Workers Comp
O
2.00
0.45
98.75
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
EPO
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
HMO
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
Medicaid
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
Medicare Part A
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
Medicare Part B
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
POS
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
PPO
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield
Workers Comp
O
2.00
0.45
0.59
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
EPO
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
HMO
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
Medicaid
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
Medicare Part A
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
Medicare Part B
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
POS
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
PPO
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
blue cross blue shield - medicare advantage
Workers Comp
O
2.00
0.45
0.45
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
EPO
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
HMO
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
Medicaid
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
Medicare Part A
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
Medicare Part B
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
POS
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
PPO
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
cigna
Workers Comp
O
2.00
0.45
1.52
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
EPO
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
HMO
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
Medicaid
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
Medicare Part A
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
Medicare Part B
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
POS
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
PPO
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
geha
Workers Comp
O
2.00
0.45
1.58
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
EPO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
HMO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
Medicaid
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
Medicare Part A
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
Medicare Part B
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
POS
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
PPO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
united healthcare
Workers Comp
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
EPO
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
HMO
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
Medicaid
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
Medicare Part A
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
Medicare Part B
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
POS
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
PPO
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
va
Workers Comp
O
2.00
0.45
2.17
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
EPO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
HMO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
Medicaid
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
Medicare Part A
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
Medicare Part B
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
POS
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
PPO
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0131
null
cpt
acetaminophen injection
worker comp
Workers Comp
O
2.00
0.45
1.63
98.75
1.20


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
EPO
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
HMO
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
Medicaid
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
Medicare Part A
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
Medicare Part B
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
POS
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
PPO
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
aetna
Workers Comp
O
5.83
1.39
81.61
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
EPO
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
HMO
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
Medicaid
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
Medicare Part A
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
Medicare Part B
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
POS
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
PPO
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield
Workers Comp
O
5.83
1.39
1.96
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
EPO
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
HMO
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
Medicaid
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
Medicare Part A
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
Medicare Part B
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
POS
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
PPO
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
blue cross blue shield - medicare advantage
Workers Comp
O
5.83
1.39
1.39
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
EPO
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
HMO
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
Medicaid
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
Medicare Part A
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
Medicare Part B
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
POS
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
PPO
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
united healthcare
Workers Comp
O
5.83
1.39
4.40
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
EPO
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
HMO
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
Medicaid
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
Medicare Part A
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
Medicare Part B
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
POS
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
PPO
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0171
null
cpt
adrenalin epinephrine inject
va
Workers Comp
O
5.83
1.39
176.05
176.05
3.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
EPO
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
HMO
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
Medicaid
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
Medicare Part A
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
Medicare Part B
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
POS
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
PPO
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0282
null
cpt
amiodarone hcl
blue cross blue shield
Workers Comp
O
20.90
8.49
8.49
8.49
12.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
EPO
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
HMO
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
Medicaid
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
Medicare Part A
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
Medicare Part B
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
POS
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
PPO
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
aetna
Workers Comp
O
97.99
24.03
46.89
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
EPO
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
HMO
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
Medicaid
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
Medicare Part A
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
Medicare Part B
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
POS
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
PPO
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield
Workers Comp
O
97.99
24.03
35.30
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
EPO
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
HMO
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
Medicaid
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
Medicare Part A
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
Medicare Part B
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
POS
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
PPO
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
blue cross blue shield - medicare advantage
Workers Comp
O
97.99
24.03
24.03
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
EPO
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
HMO
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
Medicaid
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
Medicare Part A
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
Medicare Part B
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
POS
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
PPO
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
cigna
Workers Comp
O
97.99
24.03
83.79
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
EPO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
HMO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
Medicaid
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
Medicare Part A
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
Medicare Part B
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
POS
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
PPO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
geha
Workers Comp
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
EPO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
HMO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
Medicaid
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
Medicare Part A
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
Medicare Part B
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
POS
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
PPO
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
united healthcare
Workers Comp
O
97.99
24.03
84.58
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
EPO
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
HMO
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
Medicaid
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
Medicare Part A
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
Medicare Part B
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
POS
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
PPO
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0330
null
cpt
succinycholine chloride inj
va
Workers Comp
O
97.99
24.03
101.94
101.94
58.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
EPO
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
HMO
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
Medicaid
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
Medicare Part A
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
Medicare Part B
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
POS
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
PPO
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
aetna
Workers Comp
O
85.03
30.02
39.58
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
EPO
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
HMO
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
Medicaid
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
Medicare Part A
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
Medicare Part B
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
POS
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
PPO
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield
Workers Comp
O
85.03
30.02
33.38
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
EPO
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
HMO
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
POS
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
PPO
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
85.03
30.02
30.02
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
EPO
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
HMO
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
Medicaid
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
Medicare Part A
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
Medicare Part B
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
POS
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
PPO
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0360
null
cpt
hydralazine hcl injection
united healthcare
Workers Comp
O
85.03
30.02
64.43
64.43
51.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
EPO
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
HMO
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
Medicaid
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
Medicare Part A
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
Medicare Part B
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
POS
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
PPO
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0456
null
cpt
azithromycin
blue cross blue shield
Workers Comp
O
135.23
32.54
32.54
32.54
81.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
EPO
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
HMO
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
Medicaid
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
Medicare Part A
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
Medicare Part B
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
POS
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
PPO
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield
Workers Comp
O
2.12
0.36
0.36
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
EPO
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
HMO
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
Medicaid
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
Medicare Part A
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
Medicare Part B
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
POS
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
PPO
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0461
null
cpt
atropine sulfate injection
blue cross blue shield - medicare advantage
Workers Comp
O
2.12
0.36
0.60
0.60
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
EPO
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
HMO
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
Medicaid
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
Medicare Part A
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
Medicare Part B
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
POS
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
PPO
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0475
null
cpt
baclofen 10 mg injection
tricare
Workers Comp
O
356.79
173.19
173.19
173.19
214.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
EPO
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
HMO
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
Medicaid
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
Medicare Part A
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
Medicare Part B
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
POS
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
PPO
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield
Workers Comp
O
11.13
2.66
2.66
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
EPO
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
HMO
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
Medicaid
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
Medicare Part A
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
Medicare Part B
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
POS
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
PPO
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0610
null
cpt
calcium gluconate injection
blue cross blue shield - medicare advantage
Workers Comp
O
11.13
2.66
3.33
3.33
6.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
EPO
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
HMO
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
Medicaid
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
Medicare Part A
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
Medicare Part B
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
POS
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
PPO
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
aetna
Workers Comp
O
17.80
4.17
25.32
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
EPO
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
HMO
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
Medicaid
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
Medicare Part A
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
Medicare Part B
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
POS
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
PPO
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
blue cross blue shield
Workers Comp
O
17.80
4.17
4.17
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
EPO
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
HMO
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
Medicaid
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
Medicare Part A
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
Medicare Part B
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
POS
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
PPO
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0640
null
cpt
leucovorin calcium injection
cigna
Workers Comp
O
17.80
4.17
11.89
25.32
10.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
EPO
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
HMO
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
Medicaid
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
Medicare Part A
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
Medicare Part B
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
POS
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
PPO
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
aetna
Workers Comp
O
34.76
11.90
61.54
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
EPO
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
HMO
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
Medicaid
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
Medicare Part A
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
Medicare Part B
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
POS
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
PPO
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield
Workers Comp
O
34.76
11.90
12.93
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
EPO
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
HMO
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
Medicaid
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
Medicare Part A
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
Medicare Part B
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
POS
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
PPO
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
blue cross blue shield - medicare advantage
Workers Comp
O
34.76
11.90
11.90
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
EPO
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
HMO
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
Medicaid
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
Medicare Part A
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
Medicare Part B
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
POS
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
PPO
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
cigna
Workers Comp
O
34.76
11.90
37.39
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
EPO
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
HMO
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
Medicaid
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
Medicare Part A
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
Medicare Part B
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
POS
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
PPO
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
geha
Workers Comp
O
34.76
11.90
26.07
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
EPO
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
HMO
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
Medicaid
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
Medicare Part A
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
Medicare Part B
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
POS
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
PPO
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
united healthcare
Workers Comp
O
34.76
11.90
42.10
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
EPO
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
HMO
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
Medicaid
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
Medicare Part A
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
Medicare Part B
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
POS
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
PPO
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0690
null
cpt
cefazolin sodium injection
va
Workers Comp
O
34.76
11.90
102.92
102.92
20.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
EPO
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
HMO
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
Medicaid
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
Medicare Part A
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
Medicare Part B
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
POS
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
PPO
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0692
null
cpt
cefepime hcl for injection
united healthcare
Workers Comp
O
133.72
100.29
100.29
100.29
80.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
EPO
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
HMO
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
Medicaid
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
Medicare Part A
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
Medicare Part B
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
POS
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
PPO
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0694
null
cpt
cefoxitin sodium injection
blue cross blue shield
Workers Comp
O
147.24
35.37
35.37
35.37
88.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
EPO
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
HMO
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
Medicaid
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
Medicare Part A
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
Medicare Part B
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
POS
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
PPO
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield
Workers Comp
O
32.62
12.12
12.15
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
EPO
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
HMO
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
Medicaid
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
Medicare Part A
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
Medicare Part B
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
POS
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
PPO
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
blue cross blue shield - medicare advantage
Workers Comp
O
32.62
12.12
12.12
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
EPO
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
HMO
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
Medicaid
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
Medicare Part A
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
Medicare Part B
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
POS
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
PPO
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0696
null
cpt
ceftriaxone sodium injection
united healthcare
Workers Comp
O
32.62
12.12
24.63
24.63
19.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
EPO
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
HMO
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
Medicaid
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
Medicare Part A
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
Medicare Part B
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
POS
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
PPO
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield
Workers Comp
O
31.28
1.33
14.38
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
EPO
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
HMO
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
Medicaid
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
Medicare Part A
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
Medicare Part B
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
POS
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
PPO
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
blue cross blue shield - medicare advantage
Workers Comp
O
31.28
1.33
6.53
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
EPO
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
HMO
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
Medicaid
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
Medicare Part A
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
Medicare Part B
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
POS
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
PPO
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
healthchoice
Workers Comp
O
31.28
1.33
1.33
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
EPO
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
HMO
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
Medicaid
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
Medicare Part A
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
Medicare Part B
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
POS
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
PPO
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0702
null
cpt
betamethasone acet&sod phosp
united healthcare
Workers Comp
O
31.28
1.33
93.65
93.65
18.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
EPO
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
HMO
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
Medicaid
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
Medicare Part A
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
Medicare Part B
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
POS
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
PPO
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield
Workers Comp
O
66.59
12.64
28.23
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
EPO
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
HMO
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
Medicaid
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
Medicare Part A
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
Medicare Part B
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
POS
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
PPO
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
blue cross blue shield - medicare advantage
Workers Comp
O
66.59
12.64
12.64
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
EPO
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
HMO
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
Medicaid
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
Medicare Part A
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
Medicare Part B
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
POS
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
PPO
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0744
null
cpt
ciprofloxacin iv
united healthcare
Workers Comp
O
66.59
12.64
49.95
49.95
39.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
EPO
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
HMO
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
Medicaid
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
Medicare Part A
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
Medicare Part B
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
POS
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
PPO
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield
Workers Comp
O
89.85
19.68
33.38
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
EPO
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
HMO
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
Medicaid
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
Medicare Part A
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
Medicare Part B
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
POS
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
PPO
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
blue cross blue shield - medicare advantage
Workers Comp
O
89.85
19.68
19.68
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
EPO
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
HMO
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
Medicaid
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
Medicare Part A
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
Medicare Part B
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
POS
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
PPO
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0780
null
cpt
prochlorperazine injection
va
Workers Comp
O
89.85
19.68
92.82
92.82
53.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
EPO
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
HMO
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
Medicaid
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
Medicare Part A
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
Medicare Part B
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
POS
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
PPO
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0834
null
cpt
inj. cosyntropin 0.25 mg
blue cross blue shield
Workers Comp
O
321.79
37.23
37.23
37.23
193.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
EPO
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
HMO
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
Medicaid
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
Medicare Part A
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
Medicare Part B
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
POS
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
PPO
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0878
null
cpt
daptomycin injection
blue cross blue shield
Workers Comp
O
0.42
0.09
0.09
0.09
0.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
EPO
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
HMO
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
Medicaid
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
Medicare Part A
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
Medicare Part B
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
POS
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
PPO
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
aetna
Workers Comp
O
15.58
2.74
7.43
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
EPO
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
HMO
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
Medicaid
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
Medicare Part A
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
Medicare Part B
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
POS
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
PPO
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0881
null
cpt
darbepoetin alfa non-esrd
humana - medicare advantage
Workers Comp
O
15.58
2.74
2.74
7.43
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
EPO
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
HMO
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
Medicaid
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
Medicare Part A
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
Medicare Part B
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
POS
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
PPO
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
blue cross blue shield
Workers Comp
O
48.97
7.92
14.31
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
EPO
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
HMO
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
Medicaid
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
Medicare Part A
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
Medicare Part B
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
POS
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
PPO
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0885
null
cpt
epoetin alfa non-esrd
united healthcare - medicare advantage
Workers Comp
O
48.97
7.92
7.92
14.31
29.38


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
EPO
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
HMO
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
Medicaid
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
Medicare Part A
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
Medicare Part B
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
POS
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
PPO
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
aetna
Workers Comp
O
59.36
12.85
15.49
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
EPO
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
HMO
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
Medicaid
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
Medicare Part A
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
Medicare Part B
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
POS
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
PPO
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield
Workers Comp
O
59.36
12.85
14.65
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
EPO
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
HMO
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
Medicaid
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
Medicare Part A
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
Medicare Part B
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
POS
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
PPO
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
blue cross blue shield - medicare advantage
Workers Comp
O
59.36
12.85
12.85
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
EPO
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
HMO
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
Medicaid
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
Medicare Part A
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
Medicare Part B
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
POS
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
PPO
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
humana - medicare advantage
Workers Comp
O
59.36
12.85
1714.23
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
EPO
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
HMO
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
Medicaid
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
Medicare Part A
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
Medicare Part B
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
POS
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
PPO
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
tricare
Workers Comp
O
59.36
12.85
19.34
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
EPO
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
HMO
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
Medicaid
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
Medicare Part A
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
Medicare Part B
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
POS
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
PPO
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare
Workers Comp
O
59.36
12.85
2671.20
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
EPO
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
HMO
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
Medicaid
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
Medicare Part A
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
Medicare Part B
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
POS
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
PPO
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
united healthcare - medicare advantage
Workers Comp
O
59.36
12.85
18.97
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
EPO
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
HMO
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
Medicaid
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
Medicare Part A
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
Medicare Part B
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
POS
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
PPO
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J0897
null
cpt
denosumab injection
va
Workers Comp
O
59.36
12.85
939.96
2671.20
35.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
EPO
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
HMO
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
Medicaid
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
Medicare Part A
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
Medicare Part B
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
POS
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
PPO
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
aetna
Workers Comp
O
93.44
1.54
43.41
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
EPO
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
HMO
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
Medicaid
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
Medicare Part A
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
Medicare Part B
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
POS
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
PPO
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield
Workers Comp
O
93.44
1.54
58.88
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
EPO
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
HMO
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
Medicaid
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
Medicare Part A
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
Medicare Part B
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
POS
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
PPO
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
blue cross blue shield - medicare advantage
Workers Comp
O
93.44
1.54
49.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
EPO
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
HMO
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
Medicaid
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
Medicare Part A
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
Medicare Part B
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
POS
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
PPO
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
humana - medicare advantage
Workers Comp
O
93.44
1.54
1.54
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
EPO
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
HMO
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
Medicaid
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
Medicare Part A
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
Medicare Part B
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
POS
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
PPO
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
united healthcare
Workers Comp
O
93.44
1.54
70.08
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
EPO
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
HMO
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
Medicaid
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
Medicare Part A
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
Medicare Part B
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
POS
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
PPO
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1030
null
cpt
methylprednisolone 40 mg inj
va
Workers Comp
O
93.44
1.54
6.25
70.08
56.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
EPO
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
HMO
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
Medicaid
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
Medicare Part A
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
Medicare Part B
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
POS
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
PPO
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield
Workers Comp
O
110.14
31.06
71.16
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
EPO
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
HMO
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
Medicaid
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
Medicare Part A
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
Medicare Part B
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
POS
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
PPO
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1040
null
cpt
methylprednisolone 80 mg inj
blue cross blue shield - medicare advantage
Workers Comp
O
110.14
31.06
31.06
71.16
66.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
EPO
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
HMO
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
Medicaid
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
Medicare Part A
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
Medicare Part B
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
POS
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
PPO
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
aetna
Workers Comp
O
7.92
1.67
20.42
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
EPO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
HMO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
Medicaid
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
Medicare Part A
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
Medicare Part B
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
POS
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
PPO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield
Workers Comp
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
EPO
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
HMO
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
Medicaid
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
Medicare Part A
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
Medicare Part B
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
POS
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
PPO
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
blue cross blue shield - medicare advantage
Workers Comp
O
7.92
1.67
1.68
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
EPO
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
HMO
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
Medicaid
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
Medicare Part A
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
Medicare Part B
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
POS
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
PPO
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
cigna
Workers Comp
O
7.92
1.67
5.55
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
EPO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
HMO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
Medicaid
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
Medicare Part A
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
Medicare Part B
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
POS
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
PPO
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
united healthcare
Workers Comp
O
7.92
1.67
1.67
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
EPO
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
HMO
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
Medicaid
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
Medicare Part A
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
Medicare Part B
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
POS
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
PPO
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1100
null
cpt
dexamethasone sodium phos
va
Workers Comp
O
7.92
1.67
8.50
20.42
4.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
EPO
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
HMO
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
Medicaid
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
Medicare Part A
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
Medicare Part B
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
POS
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
PPO
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
aetna
Workers Comp
O
83.42
26.04
40.78
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
EPO
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
HMO
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
Medicaid
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
Medicare Part A
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
Medicare Part B
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
POS
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
PPO
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield
Workers Comp
O
83.42
26.04
29.67
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
EPO
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
HMO
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
Medicaid
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
Medicare Part A
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
Medicare Part B
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
POS
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
PPO
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
blue cross blue shield - medicare advantage
Workers Comp
O
83.42
26.04
26.04
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
EPO
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
HMO
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
Medicaid
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
Medicare Part A
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
Medicare Part B
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
POS
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
PPO
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
cigna
Workers Comp
O
83.42
26.04
75.27
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
EPO
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
HMO
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
Medicaid
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
Medicare Part A
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
Medicare Part B
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
POS
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
PPO
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
united healthcare
Workers Comp
O
83.42
26.04
62.59
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
EPO
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
HMO
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
Medicaid
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
Medicare Part A
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
Medicare Part B
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
POS
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
PPO
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1170
null
cpt
hydromorphone injection
va
Workers Comp
O
83.42
26.04
106.24
106.24
50.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
EPO
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
HMO
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
Medicaid
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
Medicare Part A
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
Medicare Part B
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
POS
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
PPO
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
aetna
Workers Comp
O
3.33
0.75
0.98
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
EPO
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
HMO
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
Medicaid
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
Medicare Part A
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
Medicare Part B
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
POS
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
PPO
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield
Workers Comp
O
3.33
0.75
0.75
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
EPO
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
HMO
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
Medicaid
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
Medicare Part A
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
Medicare Part B
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
POS
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
PPO
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
blue cross blue shield - medicare advantage
Workers Comp
O
3.33
0.75
0.94
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
EPO
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
HMO
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
Medicaid
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
Medicare Part A
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
Medicare Part B
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
POS
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
PPO
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1200
null
cpt
diphenhydramine hcl injectio
united healthcare
Workers Comp
O
3.33
0.75
2.39
2.39
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
EPO
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
HMO
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
Medicaid
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
Medicare Part A
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
Medicare Part B
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
POS
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
PPO
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1300
null
cpt
eculizumab injection
blue cross blue shield
Workers Comp
O
868.14
141.91
141.91
141.91
520.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
EPO
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
HMO
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
Medicaid
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
Medicare Part A
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
Medicare Part B
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
POS
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
PPO
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1303
null
cpt
inj. ravulizumab-cwvz 10 mg
blue cross blue shield
Workers Comp
O
699.37
153.18
153.18
153.18
419.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
EPO
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
HMO
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
Medicaid
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
Medicare Part A
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
Medicare Part B
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
POS
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
PPO
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield
Workers Comp
O
114.91
37.49
44.53
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
EPO
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
HMO
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
Medicaid
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
Medicare Part A
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
Medicare Part B
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
POS
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
PPO
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
blue cross blue shield - medicare advantage
Workers Comp
O
114.91
37.49
37.49
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
EPO
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
HMO
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
Medicaid
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
Medicare Part A
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
Medicare Part B
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
POS
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
PPO
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1335
null
cpt
ertapenem injection
cigna
Workers Comp
O
114.91
37.49
103.84
103.84
68.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
EPO
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
HMO
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
Medicaid
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
Medicare Part A
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
Medicare Part B
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
POS
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
PPO
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
aetna - medicare advantage
Workers Comp
O
80.56
14.43
25.60
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
EPO
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
HMO
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
Medicaid
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
Medicare Part A
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
Medicare Part B
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
POS
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
PPO
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield
Workers Comp
O
80.56
14.43
16.78
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
EPO
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
HMO
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
POS
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
PPO
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
80.56
14.43
14.43
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
EPO
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
HMO
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
Medicaid
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
Medicare Part A
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
Medicare Part B
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
POS
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
PPO
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
humana - medicare advantage
Workers Comp
O
80.56
14.43
1282.01
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
EPO
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
HMO
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
Medicaid
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
Medicare Part A
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
Medicare Part B
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
POS
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
PPO
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
tricare
Workers Comp
O
80.56
14.43
25.38
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
EPO
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
HMO
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
Medicaid
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
Medicare Part A
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
Medicare Part B
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
POS
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
PPO
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1437
null
cpt
inj. fe derisomaltose 10 mg
va
Workers Comp
O
80.56
14.43
24.87
1282.01
48.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
EPO
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
HMO
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
Medicaid
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
Medicare Part A
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
Medicare Part B
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
POS
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
PPO
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna
Workers Comp
O
4.45
0.81
2.05
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
EPO
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
HMO
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
Medicaid
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
Medicare Part A
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
Medicare Part B
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
POS
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
PPO
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
aetna - medicare advantage
Workers Comp
O
4.45
0.81
0.81
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
EPO
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
HMO
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
Medicaid
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
Medicare Part A
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
Medicare Part B
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
POS
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
PPO
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield
Workers Comp
O
4.45
0.81
1.40
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
EPO
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
HMO
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
Medicaid
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
Medicare Part A
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
Medicare Part B
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
POS
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
PPO
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
blue cross blue shield - medicare advantage
Workers Comp
O
4.45
0.81
1.36
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
EPO
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
HMO
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
Medicaid
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
Medicare Part A
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
Medicare Part B
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
POS
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
PPO
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
cigna
Workers Comp
O
4.45
0.81
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
EPO
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
HMO
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
Medicaid
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
Medicare Part A
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
Medicare Part B
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
POS
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
PPO
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
tricare
Workers Comp
O
4.45
0.81
1.11
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
EPO
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
HMO
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
Medicaid
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
Medicare Part A
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
Medicare Part B
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
POS
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
PPO
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1439
null
cpt
inj ferric carboxymaltos 1mg
united healthcare - medicare advantage
Workers Comp
O
4.45
0.81
1.09
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
EPO
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
HMO
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
Medicaid
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
Medicare Part A
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
Medicare Part B
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
POS
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
PPO
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
aetna
Workers Comp
O
4.45
0.69
326.36
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
EPO
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
HMO
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
Medicaid
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
Medicare Part A
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
Medicare Part B
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
POS
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
PPO
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield
Workers Comp
O
4.45
0.69
1.40
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
EPO
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
HMO
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
Medicaid
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
Medicare Part A
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
Medicare Part B
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
POS
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
PPO
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
blue cross blue shield - medicare advantage
Workers Comp
O
4.45
0.69
1.16
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
EPO
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
HMO
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
Medicaid
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
Medicare Part A
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
Medicare Part B
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
POS
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
PPO
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
humana - medicare advantage
Workers Comp
O
4.45
0.69
0.69
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
EPO
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
HMO
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
Medicaid
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
Medicare Part A
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
Medicare Part B
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
POS
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
PPO
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
tricare
Workers Comp
O
4.45
0.69
0.93
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
EPO
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
HMO
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
Medicaid
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
Medicare Part A
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
Medicare Part B
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
POS
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
PPO
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1442
null
cpt
inj filgrastim excl biosimil
va
Workers Comp
O
4.45
0.69
462.72
462.72
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
EPO
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
HMO
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
Medicaid
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
Medicare Part A
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
Medicare Part B
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
POS
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
PPO
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
aetna
Workers Comp
O
954.00
0.79
460.23
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
EPO
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
HMO
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
Medicaid
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
Medicare Part A
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
Medicare Part B
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
POS
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
PPO
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield
Workers Comp
O
954.00
0.79
1.60
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
EPO
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
HMO
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
Medicaid
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
Medicare Part A
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
Medicare Part B
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
POS
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
PPO
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
blue cross blue shield - medicare advantage
Workers Comp
O
954.00
0.79
1.95
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
EPO
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
HMO
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
Medicaid
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
Medicare Part A
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
Medicare Part B
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
POS
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
PPO
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
cigna
Workers Comp
O
954.00
0.79
4.46
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
EPO
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
HMO
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
Medicaid
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
Medicare Part A
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
Medicare Part B
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
POS
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
PPO
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
humana - medicare advantage
Workers Comp
O
954.00
0.79
1.29
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
EPO
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
HMO
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
Medicaid
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
Medicare Part A
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
Medicare Part B
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
POS
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
PPO
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
tricare
Workers Comp
O
954.00
0.79
0.79
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
EPO
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
HMO
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
Medicaid
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
Medicare Part A
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
Medicare Part B
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
POS
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
PPO
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare
Workers Comp
O
954.00
0.79
360.14
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
EPO
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
HMO
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
Medicaid
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
Medicare Part A
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
Medicare Part B
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
POS
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
PPO
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
united healthcare - medicare advantage
Workers Comp
O
954.00
0.79
1.08
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
EPO
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
HMO
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
Medicaid
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
Medicare Part A
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
Medicare Part B
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
POS
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
PPO
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1453
null
cpt
fosaprepitant injection
va
Workers Comp
O
954.00
0.79
36.45
460.23
572.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
EPO
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
HMO
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
Medicaid
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
Medicare Part A
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
Medicare Part B
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
POS
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
PPO
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1454
null
cpt
inj fosnetupitant palonoset
blue cross blue shield - medicare advantage
Workers Comp
O
817.95
294.66
294.66
294.66
490.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
EPO
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
HMO
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
Medicaid
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
Medicare Part A
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
Medicare Part B
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
POS
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
PPO
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1459
null
cpt
inj ivig privigen 500 mg
tricare
Workers Comp
O
109.59
41.50
41.50
41.50
65.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
EPO
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
HMO
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
Medicaid
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
Medicare Part A
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
Medicare Part B
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
POS
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
PPO
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1561
null
cpt
gamunex-c/gammaked
tricare
Workers Comp
O
11293.28
48.22
48.22
48.22
6775.97


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
EPO
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
HMO
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
Medicaid
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
Medicare Part A
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
Medicare Part B
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
POS
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
PPO
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield
Workers Comp
O
71.11
3.13
32.18
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
EPO
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
HMO
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
Medicaid
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
Medicare Part A
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
Medicare Part B
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
POS
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
PPO
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1580
null
cpt
garamycin gentamicin inj
blue cross blue shield - medicare advantage
Workers Comp
O
71.11
3.13
3.13
32.18
42.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
EPO
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
HMO
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
Medicaid
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
Medicare Part A
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
Medicare Part B
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
POS
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
PPO
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1630
null
cpt
haloperidol injection
blue cross blue shield
Workers Comp
O
91.12
29.37
29.37
29.37
54.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
EPO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
HMO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
Medicaid
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
Medicare Part A
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
Medicare Part B
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
POS
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
PPO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield
Workers Comp
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
EPO
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
HMO
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
Medicaid
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
Medicare Part A
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
Medicare Part B
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
POS
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
PPO
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
blue cross blue shield - medicare advantage
Workers Comp
O
2.12
0.66
0.81
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
EPO
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
HMO
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
Medicaid
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
Medicare Part A
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
Medicare Part B
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
POS
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
PPO
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
tricare
Workers Comp
O
2.12
0.66
2.22
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
EPO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
HMO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
Medicaid
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
Medicare Part A
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
Medicare Part B
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
POS
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
PPO
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
united healthcare
Workers Comp
O
2.12
0.66
1.59
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
EPO
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
HMO
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
Medicaid
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
Medicare Part A
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
Medicare Part B
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
POS
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
PPO
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1642
null
cpt
inj heparin sodium per 10 u
va
Workers Comp
O
2.12
0.66
0.66
2.22
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
EPO
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
HMO
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
Medicaid
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
Medicare Part A
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
Medicare Part B
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
POS
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
PPO
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
aetna
Workers Comp
O
8.03
2.20
40.99
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
EPO
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
HMO
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
Medicaid
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
Medicare Part A
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
Medicare Part B
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
POS
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
PPO
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield
Workers Comp
O
8.03
2.20
2.20
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
EPO
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
HMO
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
Medicaid
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
Medicare Part A
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
Medicare Part B
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
POS
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
PPO
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
blue cross blue shield - medicare advantage
Workers Comp
O
8.03
2.20
2.39
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
EPO
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
HMO
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
Medicaid
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
Medicare Part A
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
Medicare Part B
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
POS
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
PPO
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1644
null
cpt
inj heparin sodium per 1000u
united healthcare
Workers Comp
O
8.03
2.20
110.08
110.08
4.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
EPO
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
HMO
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
Medicaid
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
Medicare Part A
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
Medicare Part B
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
POS
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
PPO
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield
Workers Comp
O
21.44
6.16
7.98
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
EPO
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
HMO
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
Medicaid
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
Medicare Part A
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
Medicare Part B
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
POS
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
PPO
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1650
null
cpt
inj enoxaparin sodium
blue cross blue shield - medicare advantage
Workers Comp
O
21.44
6.16
6.16
7.98
12.86


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
EPO
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
HMO
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
Medicaid
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
Medicare Part A
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
Medicare Part B
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
POS
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
PPO
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1741
null
cpt
ibuprofen injection
blue cross blue shield
Workers Comp
O
4.73
1.62
1.62
1.62
2.84


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
EPO
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
HMO
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
Medicaid
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
Medicare Part A
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
Medicare Part B
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
POS
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
PPO
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
aetna
Workers Comp
O
5640.20
57.35
5172.59
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
EPO
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
HMO
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
Medicaid
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
Medicare Part A
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
Medicare Part B
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
POS
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
PPO
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1745
null
cpt
infliximab not biosimil 10mg
tricare
Workers Comp
O
5640.20
57.35
57.35
5172.59
3384.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
EPO
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
HMO
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
Medicaid
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
Medicare Part A
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
Medicare Part B
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
POS
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
PPO
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
aetna
Workers Comp
O
39.78
13.48
18.27
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
EPO
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
HMO
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
Medicaid
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
Medicare Part A
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
Medicare Part B
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
POS
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
PPO
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield
Workers Comp
O
39.78
13.48
13.51
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
EPO
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
HMO
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
Medicaid
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
Medicare Part A
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
Medicare Part B
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
POS
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
PPO
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
blue cross blue shield - medicare advantage
Workers Comp
O
39.78
13.48
13.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
EPO
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
HMO
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
Medicaid
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
Medicare Part A
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
Medicare Part B
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
POS
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
PPO
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
cigna
Workers Comp
O
39.78
13.48
27.71
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
EPO
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
HMO
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
Medicaid
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
Medicare Part A
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
Medicare Part B
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
POS
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
PPO
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1885
null
cpt
ketorolac tromethamine inj
va
Workers Comp
O
39.78
13.48
79.48
79.48
23.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
EPO
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
HMO
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
Medicaid
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
Medicare Part A
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
Medicare Part B
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
POS
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
PPO
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield
Workers Comp
O
39.42
5.42
16.85
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
EPO
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
HMO
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
Medicaid
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
Medicare Part A
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
Medicare Part B
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
POS
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
PPO
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
blue cross blue shield - medicare advantage
Workers Comp
O
39.42
5.42
5.42
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
EPO
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
HMO
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
Medicaid
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
Medicare Part A
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
Medicare Part B
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
POS
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
PPO
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1940
null
cpt
furosemide injection
united healthcare
Workers Comp
O
39.42
5.42
44.62
44.62
23.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
EPO
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
HMO
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
Medicaid
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
Medicare Part A
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
Medicare Part B
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
POS
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
PPO
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
blue cross blue shield
Workers Comp
O
3493.76
832.50
832.50
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
EPO
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
HMO
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
Medicaid
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
Medicare Part A
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
Medicare Part B
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
POS
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
PPO
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1950
null
cpt
leuprolide acetate /3.75 mg
united healthcare
Workers Comp
O
3493.76
832.50
2620.32
2620.32
2096.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
EPO
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
HMO
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
Medicaid
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
Medicare Part A
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
Medicare Part B
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
POS
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
PPO
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
aetna
Workers Comp
O
66.45
16.35
62.47
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
EPO
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
HMO
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
Medicaid
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
Medicare Part A
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
Medicare Part B
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
POS
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
PPO
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield
Workers Comp
O
66.45
16.35
24.57
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
EPO
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
HMO
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
Medicaid
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
Medicare Part A
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
Medicare Part B
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
POS
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
PPO
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J1956
null
cpt
levofloxacin injection
blue cross blue shield - medicare advantage
Workers Comp
O
66.45
16.35
16.35
62.47
39.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
EPO
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
HMO
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
Medicaid
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
Medicare Part A
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
Medicare Part B
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
POS
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
PPO
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield
Workers Comp
O
8.36
2.68
3.77
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
EPO
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
HMO
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
Medicaid
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
Medicare Part A
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
Medicare Part B
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
POS
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
PPO
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
blue cross blue shield - medicare advantage
Workers Comp
O
8.36
2.68
2.68
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
EPO
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
HMO
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
Medicaid
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
Medicare Part A
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
Medicare Part B
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
POS
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
PPO
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
cigna
Workers Comp
O
8.36
2.68
6.21
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
EPO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
HMO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
Medicaid
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
Medicare Part A
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
Medicare Part B
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
POS
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
PPO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
geha
Workers Comp
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
EPO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
HMO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
Medicaid
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
Medicare Part A
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
Medicare Part B
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
POS
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
PPO
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
united healthcare
Workers Comp
O
8.36
2.68
6.27
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
EPO
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
HMO
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
Medicaid
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
Medicare Part A
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
Medicare Part B
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
POS
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
PPO
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2001
null
cpt
lidocaine injection
va
Workers Comp
O
8.36
2.68
8.36
8.36
5.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
EPO
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
HMO
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
Medicaid
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
Medicare Part A
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
Medicare Part B
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
POS
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
PPO
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
aetna
Workers Comp
O
78.27
26.40
36.79
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
EPO
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
HMO
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
Medicaid
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
Medicare Part A
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
Medicare Part B
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
POS
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
PPO
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield
Workers Comp
O
78.27
26.40
26.40
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
EPO
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
HMO
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
Medicaid
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
Medicare Part A
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
Medicare Part B
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
POS
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
PPO
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
blue cross blue shield - medicare advantage
Workers Comp
O
78.27
26.40
27.31
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
EPO
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
HMO
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
Medicaid
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
Medicare Part A
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
Medicare Part B
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
POS
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
PPO
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2060
null
cpt
lorazepam injection
va
Workers Comp
O
78.27
26.40
78.28
78.28
46.96


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
EPO
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
HMO
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
Medicaid
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
Medicare Part A
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
Medicare Part B
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
POS
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
PPO
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
aetna
Workers Comp
O
7.79
2.81
3.58
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
EPO
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
HMO
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
Medicaid
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
Medicare Part A
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
Medicare Part B
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
POS
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
PPO
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield
Workers Comp
O
7.79
2.81
2.81
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
EPO
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
HMO
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
Medicaid
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
Medicare Part A
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
Medicare Part B
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
POS
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
PPO
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
blue cross blue shield - medicare advantage
Workers Comp
O
7.79
2.81
12.38
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
EPO
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
HMO
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
Medicaid
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
Medicare Part A
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
Medicare Part B
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
POS
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
PPO
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2150
null
cpt
mannitol injection
united healthcare
Workers Comp
O
7.79
2.81
5.57
12.38
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
EPO
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
HMO
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
Medicaid
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
Medicare Part A
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
Medicare Part B
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
POS
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
PPO
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
aetna
Workers Comp
O
85.95
27.23
39.86
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
EPO
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
HMO
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
Medicaid
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
Medicare Part A
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
Medicare Part B
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
POS
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
PPO
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield
Workers Comp
O
85.95
27.23
30.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
EPO
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
HMO
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
Medicaid
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
POS
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
PPO
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
blue cross blue shield - medicare advantage
Workers Comp
O
85.95
27.23
27.23
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
EPO
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
HMO
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
Medicaid
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
Medicare Part A
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
Medicare Part B
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
POS
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
PPO
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
cigna
Workers Comp
O
85.95
27.23
58.42
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
EPO
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
HMO
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
Medicaid
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
Medicare Part A
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
Medicare Part B
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
POS
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
PPO
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
geha
Workers Comp
O
85.95
27.23
64.49
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
EPO
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
HMO
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
Medicaid
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
Medicare Part A
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
Medicare Part B
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
POS
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
PPO
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2175
null
cpt
meperidine hydrochl /100 mg
va
Workers Comp
O
85.95
27.23
86.65
86.65
51.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
EPO
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
HMO
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
Medicaid
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
Medicare Part A
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
Medicare Part B
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
POS
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
PPO
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2182
null
cpt
injection mepolizumab 1mg
tricare
Workers Comp
O
70.26
29.29
29.29
29.29
42.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
EPO
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
HMO
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
Medicaid
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
Medicare Part A
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
Medicare Part B
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
POS
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
PPO
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2185
null
cpt
meropenem
va
Workers Comp
O
3.77
0.90
0.90
0.90
2.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
EPO
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
HMO
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
Medicaid
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
Medicare Part A
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
Medicare Part B
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
POS
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
PPO
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield
Workers Comp
O
129.25
21.47
33.76
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
EPO
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
HMO
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
Medicaid
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
Medicare Part A
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
Medicare Part B
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
POS
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
PPO
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2210
null
cpt
methylergonovin maleate inj
blue cross blue shield - medicare advantage
Workers Comp
O
129.25
21.47
21.47
33.76
77.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
EPO
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
HMO
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
Medicaid
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
Medicare Part A
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
Medicare Part B
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
POS
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
PPO
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
aetna
Workers Comp
O
41.06
10.24
38.06
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
EPO
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
HMO
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
Medicaid
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
Medicare Part A
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
Medicare Part B
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
POS
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
PPO
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield
Workers Comp
O
41.06
10.24
12.01
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
EPO
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
HMO
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
Medicaid
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
Medicare Part A
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
Medicare Part B
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
POS
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
PPO
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
blue cross blue shield - medicare advantage
Workers Comp
O
41.06
10.24
10.24
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
EPO
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
HMO
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
Medicaid
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
Medicare Part A
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
Medicare Part B
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
POS
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
PPO
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
cigna
Workers Comp
O
41.06
10.24
30.74
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
EPO
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
HMO
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
Medicaid
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
Medicare Part A
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
Medicare Part B
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
POS
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
PPO
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
geha
Workers Comp
O
41.06
10.24
31.25
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
EPO
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
HMO
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
Medicaid
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
Medicare Part A
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
Medicare Part B
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
POS
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
PPO
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
united healthcare
Workers Comp
O
41.06
10.24
31.03
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
EPO
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
HMO
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
Medicaid
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
Medicare Part A
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
Medicare Part B
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
POS
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
PPO
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2250
null
cpt
inj midazolam hydrochloride
va
Workers Comp
O
41.06
10.24
29.09
38.06
24.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
EPO
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
HMO
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
Medicaid
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
Medicare Part A
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
Medicare Part B
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
POS
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
PPO
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
aetna
Workers Comp
O
85.07
21.66
41.47
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
EPO
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
HMO
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
Medicaid
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
Medicare Part A
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
Medicare Part B
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
POS
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
PPO
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield
Workers Comp
O
85.07
21.66
25.19
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
EPO
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
HMO
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
Medicaid
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
Medicare Part A
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
Medicare Part B
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
POS
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
PPO
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
blue cross blue shield - medicare advantage
Workers Comp
O
85.07
21.66
21.66
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
EPO
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
HMO
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
Medicaid
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
Medicare Part A
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
Medicare Part B
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
POS
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
PPO
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
cigna
Workers Comp
O
85.07
21.66
95.67
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
EPO
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
HMO
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
Medicaid
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
Medicare Part A
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
Medicare Part B
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
POS
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
PPO
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2270
null
cpt
morphine sulfate injection
united healthcare
Workers Comp
O
85.07
21.66
64.18
95.67
51.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
EPO
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
HMO
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
Medicaid
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
Medicare Part A
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
Medicare Part B
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
POS
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
PPO
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2274
null
cpt
inj morphine pf epid ithc
blue cross blue shield
Workers Comp
O
52.96
0.72
0.72
0.72
31.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
EPO
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
HMO
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
Medicaid
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
Medicare Part A
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
Medicare Part B
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
POS
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
PPO
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield
Workers Comp
O
100.20
19.96
32.43
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
EPO
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
HMO
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
Medicaid
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
Medicare Part A
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
Medicare Part B
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
POS
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
PPO
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2310
null
cpt
inj naloxone hydrochloride
blue cross blue shield - medicare advantage
Workers Comp
O
100.20
19.96
19.96
32.43
60.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
EPO
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
HMO
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
Medicaid
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
Medicare Part A
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
Medicare Part B
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
POS
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
PPO
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2323
null
cpt
natalizumab injection
blue cross blue shield
Workers Comp
O
59.10
17.76
17.76
17.76
35.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
EPO
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
HMO
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
Medicaid
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
Medicare Part A
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
Medicare Part B
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
POS
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
PPO
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2350
null
cpt
injection ocrelizumab 1 mg
tricare
Workers Comp
O
83840.50
58.29
58.29
58.29
50304.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
EPO
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
HMO
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
Medicaid
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
Medicare Part A
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
Medicare Part B
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
POS
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
PPO
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
blue cross blue shield
Workers Comp
O
635.52
139.30
139.30
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
EPO
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
HMO
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
Medicaid
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
Medicare Part A
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
Medicare Part B
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
POS
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
PPO
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2353
null
cpt
octreotide injection depot
humana - medicare advantage
Workers Comp
O
635.52
139.30
6161.16
6161.16
381.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
EPO
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
HMO
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
Medicaid
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
Medicare Part A
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
Medicare Part B
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
POS
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
PPO
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2354
null
cpt
octreotide inj non-depot
united healthcare
Workers Comp
O
85.86
64.40
64.40
64.40
51.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
EPO
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
HMO
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
Medicaid
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
Medicare Part A
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
Medicare Part B
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
POS
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
PPO
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2357
null
cpt
omalizumab injection
blue cross blue shield
Workers Comp
O
96.86
14.41
14.41
14.41
58.12


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
EPO
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
HMO
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
Medicaid
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
Medicare Part A
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
Medicare Part B
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
POS
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
PPO
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
aetna
Workers Comp
O
87.77
21.81
40.37
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
EPO
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
HMO
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
Medicaid
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
Medicare Part A
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
Medicare Part B
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
POS
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
PPO
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield
Workers Comp
O
87.77
21.81
28.90
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
EPO
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
HMO
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
POS
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
PPO
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
87.77
21.81
21.81
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
EPO
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
HMO
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
Medicaid
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
Medicare Part A
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
Medicare Part B
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
POS
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
PPO
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
cigna
Workers Comp
O
87.77
21.81
65.21
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
EPO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
HMO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
Medicaid
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
Medicare Part A
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
Medicare Part B
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
POS
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
PPO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
united healthcare
Workers Comp
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
EPO
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
HMO
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
Medicaid
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
Medicare Part A
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
Medicare Part B
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
POS
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
PPO
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
va
Workers Comp
O
87.77
21.81
87.77
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
EPO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
HMO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
Medicaid
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
Medicare Part A
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
Medicare Part B
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
POS
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
PPO
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2370
null
cpt
phenylephrine hcl injection
worker comp
Workers Comp
O
87.77
21.81
65.83
87.77
52.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
EPO
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
HMO
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
Medicaid
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
Medicare Part A
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
Medicare Part B
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
POS
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
PPO
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
aetna
Workers Comp
O
19.54
5.25
35.96
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
EPO
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
HMO
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
Medicaid
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
Medicare Part A
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
Medicare Part B
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
POS
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
PPO
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield
Workers Comp
O
19.54
5.25
6.46
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
EPO
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
HMO
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
POS
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
PPO
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
19.54
5.25
5.25
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
EPO
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
HMO
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
Medicaid
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
Medicare Part A
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
Medicare Part B
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
POS
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
PPO
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
cigna
Workers Comp
O
19.54
5.25
14.53
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
EPO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
HMO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
Medicaid
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
Medicare Part A
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
Medicare Part B
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
POS
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
PPO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
united healthcare
Workers Comp
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
EPO
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
HMO
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
Medicaid
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
Medicare Part A
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
Medicare Part B
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
POS
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
PPO
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
va
Workers Comp
O
19.54
5.25
19.55
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
EPO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
HMO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
Medicaid
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
Medicare Part A
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
Medicare Part B
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
POS
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
PPO
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2405
null
cpt
ondansetron hcl injection
worker comp
Workers Comp
O
19.54
5.25
14.66
35.96
11.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
EPO
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
HMO
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
Medicaid
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
Medicare Part A
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
Medicare Part B
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
POS
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
PPO
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
blue cross blue shield - medicare advantage
Workers Comp
O
4868.68
13.08
13.08
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
EPO
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
HMO
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
Medicaid
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
Medicare Part A
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
Medicare Part B
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
POS
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
PPO
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
tricare
Workers Comp
O
4868.68
13.08
23.96
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
EPO
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
HMO
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
Medicaid
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
Medicare Part A
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
Medicare Part B
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
POS
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
PPO
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2407
null
cpt
injection oritavancin
va
Workers Comp
O
4868.68
13.08
23.63
23.96
2921.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
EPO
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
HMO
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
Medicaid
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
Medicare Part A
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
Medicare Part B
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
POS
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
PPO
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna
Workers Comp
O
85.70
7.93
394.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
EPO
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
HMO
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
Medicaid
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
Medicare Part A
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
Medicare Part B
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
POS
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
PPO
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
aetna - medicare advantage
Workers Comp
O
85.70
7.93
857.00
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
EPO
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
HMO
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
Medicaid
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
Medicare Part A
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
Medicare Part B
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
POS
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
PPO
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield
Workers Comp
O
85.70
7.93
19.91
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
EPO
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
HMO
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
Medicaid
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
Medicare Part A
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
Medicare Part B
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
POS
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
PPO
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
blue cross blue shield - medicare advantage
Workers Comp
O
85.70
7.93
21.56
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
EPO
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
HMO
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
Medicaid
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
Medicare Part A
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
Medicare Part B
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
POS
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
PPO
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
cigna
Workers Comp
O
85.70
7.93
57.22
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
EPO
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
HMO
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
Medicaid
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
Medicare Part A
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
Medicare Part B
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
POS
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
PPO
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
tricare
Workers Comp
O
85.70
7.93
7.93
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
EPO
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
HMO
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
Medicaid
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
Medicare Part A
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
Medicare Part B
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
POS
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
PPO
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2469
null
cpt
palonosetron hcl
united healthcare
Workers Comp
O
85.70
7.93
64.28
857.00
51.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
EPO
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
HMO
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
Medicaid
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
Medicare Part A
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
Medicare Part B
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
POS
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
PPO
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
aetna
Workers Comp
O
17508.60
2221.63
8053.96
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
EPO
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
HMO
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
Medicaid
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
Medicare Part A
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
Medicare Part B
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
POS
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
PPO
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield
Workers Comp
O
17508.60
2221.63
3728.31
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
EPO
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
HMO
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
Medicaid
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
Medicare Part A
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
Medicare Part B
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
POS
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
PPO
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
blue cross blue shield - medicare advantage
Workers Comp
O
17508.60
2221.63
4691.39
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
EPO
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
HMO
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
Medicaid
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
Medicare Part A
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
Medicare Part B
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
POS
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
PPO
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
humana - medicare advantage
Workers Comp
O
17508.60
2221.63
3566.46
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
EPO
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
HMO
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
Medicaid
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
Medicare Part A
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
Medicare Part B
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
POS
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
PPO
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
tricare
Workers Comp
O
17508.60
2221.63
3983.14
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
EPO
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
HMO
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
Medicaid
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
Medicare Part A
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
Medicare Part B
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
POS
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
PPO
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2505
null
cpt
injection pegfilgrastim 6mg
va
Workers Comp
O
17508.60
2221.63
2221.63
8053.96
10505.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
EPO
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
HMO
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
Medicaid
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
Medicare Part A
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
Medicare Part B
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
POS
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
PPO
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
aetna
Workers Comp
O
4.12
0.55
37.88
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
EPO
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
HMO
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
Medicaid
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
Medicare Part A
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
Medicare Part B
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
POS
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
PPO
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield
Workers Comp
O
4.12
0.55
1.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
EPO
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
HMO
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
POS
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
PPO
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
4.12
0.55
1.40
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
EPO
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
HMO
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
Medicaid
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
Medicare Part A
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
Medicare Part B
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
POS
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
PPO
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
cigna
Workers Comp
O
4.12
0.55
3.07
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
EPO
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
HMO
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
Medicaid
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
Medicare Part A
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
Medicare Part B
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
POS
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
PPO
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
geha
Workers Comp
O
4.12
0.55
2.37
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
EPO
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
HMO
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
Medicaid
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
Medicare Part A
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
Medicare Part B
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
POS
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
PPO
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
healthchoice
Workers Comp
O
4.12
0.55
0.55
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
EPO
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
HMO
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
Medicaid
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
Medicare Part A
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
Medicare Part B
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
POS
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
PPO
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
humana - medicare advantage
Workers Comp
O
4.12
0.55
65.74
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
EPO
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
HMO
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
Medicaid
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
Medicare Part A
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
Medicare Part B
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
POS
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
PPO
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
medica
Workers Comp
O
4.12
0.55
1.62
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
EPO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
HMO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
Medicaid
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
Medicare Part A
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
Medicare Part B
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
POS
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
PPO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
united healthcare
Workers Comp
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
EPO
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
HMO
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
Medicaid
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
Medicare Part A
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
Medicare Part B
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
POS
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
PPO
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
va
Workers Comp
O
4.12
0.55
4.12
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
EPO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
HMO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
Medicaid
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
Medicare Part A
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
Medicare Part B
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
POS
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
PPO
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2704
null
cpt
inj propofol 10 mg
worker comp
Workers Comp
O
4.12
0.55
3.09
65.74
2.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
EPO
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
HMO
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
Medicaid
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
Medicare Part A
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
Medicare Part B
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
POS
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
PPO
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
aetna
Workers Comp
O
4.65
1.33
30.64
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
EPO
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
HMO
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
Medicaid
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
Medicare Part A
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
Medicare Part B
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
POS
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
PPO
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield
Workers Comp
O
4.65
1.33
1.72
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
EPO
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
HMO
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
Medicaid
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
Medicare Part A
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
Medicare Part B
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
POS
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
PPO
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
blue cross blue shield - medicare advantage
Workers Comp
O
4.65
1.33
1.33
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
EPO
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
HMO
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
Medicaid
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
Medicare Part A
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
Medicare Part B
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
POS
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
PPO
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
cigna
Workers Comp
O
4.65
1.33
3.26
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
EPO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
HMO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
Medicaid
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
Medicare Part A
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
Medicare Part B
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
POS
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
PPO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
geha
Workers Comp
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
EPO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
HMO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
Medicaid
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
Medicare Part A
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
Medicare Part B
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
POS
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
PPO
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
united healthcare
Workers Comp
O
4.65
1.33
3.49
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
EPO
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
HMO
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
Medicaid
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
Medicare Part A
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
Medicare Part B
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
POS
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
PPO
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2710
null
cpt
neostigmine methylslfte inj
va
Workers Comp
O
4.65
1.33
93.14
93.14
2.79


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
EPO
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
HMO
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
Medicaid
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
Medicare Part A
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
Medicare Part B
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
POS
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
PPO
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
aetna
Workers Comp
O
79.58
18.08
37.01
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
EPO
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
HMO
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
Medicaid
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
Medicare Part A
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
Medicare Part B
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
POS
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
PPO
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield
Workers Comp
O
79.58
18.08
29.35
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
EPO
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
HMO
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
POS
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
PPO
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
79.58
18.08
18.08
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
EPO
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
HMO
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
Medicaid
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
Medicare Part A
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
Medicare Part B
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
POS
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
PPO
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
cigna
Workers Comp
O
79.58
18.08
55.90
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
EPO
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
HMO
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
Medicaid
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
Medicare Part A
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
Medicare Part B
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
POS
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
PPO
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2765
null
cpt
metoclopramide hcl injection
va
Workers Comp
O
79.58
18.08
81.46
81.46
47.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
EPO
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
HMO
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
Medicaid
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
Medicare Part A
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
Medicare Part B
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
POS
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
PPO
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield
Workers Comp
O
4.24
1.31
1.52
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
EPO
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
HMO
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
Medicaid
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
Medicare Part A
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
Medicare Part B
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
POS
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
PPO
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2780
null
cpt
ranitidine hydrochloride inj
blue cross blue shield - medicare advantage
Workers Comp
O
4.24
1.31
1.31
1.52
2.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
EPO
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
HMO
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
Medicaid
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
Medicare Part A
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
Medicare Part B
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
POS
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
PPO
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna
Workers Comp
O
152.34
26.38
69.40
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
EPO
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
HMO
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
Medicaid
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
Medicare Part A
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
Medicare Part B
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
POS
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
PPO
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
aetna - medicare advantage
Workers Comp
O
152.34
26.38
286.46
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
EPO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
HMO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
Medicaid
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
Medicare Part A
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
Medicare Part B
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
POS
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
PPO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield
Workers Comp
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
EPO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
HMO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
Medicaid
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
Medicare Part A
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
Medicare Part B
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
POS
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
PPO
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
blue cross blue shield - medicare advantage
Workers Comp
O
152.34
26.38
26.38
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
EPO
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
HMO
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
Medicaid
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
Medicare Part A
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
Medicare Part B
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
POS
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
PPO
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
cigna
Workers Comp
O
152.34
26.38
95.88
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
EPO
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
HMO
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
Medicaid
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
Medicare Part A
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
Medicare Part B
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
POS
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
PPO
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
united healthcare
Workers Comp
O
152.34
26.38
457.03
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
EPO
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
HMO
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
Medicaid
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
Medicare Part A
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
Medicare Part B
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
POS
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
PPO
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2785
null
cpt
regadenoson injection
va
Workers Comp
O
152.34
26.38
59.22
457.03
91.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
EPO
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
HMO
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
Medicaid
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
Medicare Part A
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
Medicare Part B
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
POS
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
PPO
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield
Workers Comp
O
0.95
0.20
0.24
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
EPO
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
HMO
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
POS
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
PPO
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
0.95
0.20
0.20
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
EPO
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
HMO
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
Medicaid
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
Medicare Part A
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
Medicare Part B
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
POS
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
PPO
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2795
null
cpt
ropivacaine hcl injection
cigna
Workers Comp
O
0.95
0.20
0.44
0.44
0.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
EPO
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
HMO
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
Medicaid
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
Medicare Part A
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
Medicare Part B
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
POS
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
PPO
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2920
null
cpt
methylprednisolone injection
blue cross blue shield
Workers Comp
O
12.24
2.41
2.41
2.41
7.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
EPO
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
HMO
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
Medicaid
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
Medicare Part A
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
Medicare Part B
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
POS
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
PPO
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2930
null
cpt
methylprednisolone injection
blue cross blue shield
Workers Comp
O
95.01
22.69
22.69
22.69
57.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
EPO
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
HMO
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
Medicaid
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
Medicare Part A
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
Medicare Part B
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
POS
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
PPO
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
aetna
Workers Comp
O
572.40
71.07
1116.50
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
EPO
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
HMO
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
Medicaid
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
Medicare Part A
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
Medicare Part B
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
POS
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
PPO
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
blue cross blue shield
Workers Comp
O
572.40
71.07
71.07
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
EPO
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
HMO
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
Medicaid
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
Medicare Part A
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
Medicare Part B
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
POS
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
PPO
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
humana - medicare advantage
Workers Comp
O
572.40
71.07
95.66
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
EPO
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
HMO
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
Medicaid
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
Medicare Part A
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
Medicare Part B
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
POS
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
PPO
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
tricare
Workers Comp
O
572.40
71.07
87.15
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
EPO
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
HMO
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
Medicaid
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
Medicare Part A
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
Medicare Part B
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
POS
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
PPO
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J2997
null
cpt
alteplase recombinant
united healthcare
Workers Comp
O
572.40
71.07
429.30
1116.50
343.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
EPO
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
HMO
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
Medicaid
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
Medicare Part A
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
Medicare Part B
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
POS
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
PPO
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
aetna
Workers Comp
O
82.61
12.81
39.01
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
EPO
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
HMO
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
Medicaid
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
Medicare Part A
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
Medicare Part B
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
POS
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
PPO
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield
Workers Comp
O
82.61
12.81
14.19
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
EPO
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
HMO
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
Medicaid
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
Medicare Part A
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
Medicare Part B
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
POS
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
PPO
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
blue cross blue shield - medicare advantage
Workers Comp
O
82.61
12.81
12.81
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
EPO
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
HMO
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
Medicaid
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
Medicare Part A
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
Medicare Part B
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
POS
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
PPO
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
cigna
Workers Comp
O
82.61
12.81
31.61
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
EPO
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
HMO
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
Medicaid
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
Medicare Part A
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
Medicare Part B
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
POS
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
PPO
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
geha
Workers Comp
O
82.61
12.81
21.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
EPO
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
HMO
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
Medicaid
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
Medicare Part A
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
Medicare Part B
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
POS
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
PPO
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
united healthcare
Workers Comp
O
82.61
12.81
62.52
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
EPO
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
HMO
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
Medicaid
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
Medicare Part A
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
Medicare Part B
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
POS
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
PPO
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
va
Workers Comp
O
82.61
12.81
84.62
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
EPO
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
HMO
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
Medicaid
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
Medicare Part A
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
Medicare Part B
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
POS
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
PPO
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3010
null
cpt
fentanyl citrate injection
worker comp
Workers Comp
O
82.61
12.81
42.39
84.62
49.57


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
EPO
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
HMO
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
Medicaid
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
Medicare Part A
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
Medicare Part B
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
POS
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
PPO
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3105
null
cpt
terbutaline sulfate inj
blue cross blue shield
Workers Comp
O
80.68
80.68
80.68
80.68
48.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
EPO
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
HMO
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
Medicaid
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
Medicare Part A
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
Medicare Part B
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
POS
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
PPO
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
blue cross blue shield
Workers Comp
O
5807.63
991.49
991.49
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
EPO
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
HMO
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
Medicaid
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
Medicare Part A
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
Medicare Part B
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
POS
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
PPO
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3240
null
cpt
thyrotropin injection
tricare
Workers Comp
O
5807.63
991.49
1776.21
1776.21
3484.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
EPO
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
HMO
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
Medicaid
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
Medicare Part A
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
Medicare Part B
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
POS
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
PPO
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield
Workers Comp
O
18.37
5.70
5.70
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
EPO
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
HMO
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
Medicaid
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
Medicare Part A
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
Medicare Part B
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
POS
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
PPO
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3246
null
cpt
tirofiban hcl
blue cross blue shield - medicare advantage
Workers Comp
O
18.37
5.70
10.88
10.88
11.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
EPO
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
HMO
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
Medicaid
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
Medicare Part A
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
Medicare Part B
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
POS
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
PPO
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield
Workers Comp
O
23.69
5.79
7.39
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
EPO
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
HMO
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
Medicaid
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
Medicare Part A
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
Medicare Part B
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
POS
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
PPO
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3301
null
cpt
triamcinolone acet inj nos
blue cross blue shield - medicare advantage
Workers Comp
O
23.69
5.79
5.79
7.39
14.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
EPO
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
HMO
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
Medicaid
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
Medicare Part A
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
Medicare Part B
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
POS
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
PPO
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3358
null
cpt
ustekinumab iv inject 1 mg
blue cross blue shield
Workers Comp
O
33.81
16.78
16.78
16.78
20.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
EPO
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
HMO
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
Medicaid
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
Medicare Part A
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
Medicare Part B
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
POS
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
PPO
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
aetna
Workers Comp
O
75.38
17.22
84.24
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
EPO
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
HMO
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
Medicaid
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
Medicare Part A
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
Medicare Part B
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
POS
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
PPO
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield
Workers Comp
O
75.38
17.22
27.09
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
EPO
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
HMO
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
POS
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
PPO
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
75.38
17.22
17.22
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
EPO
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
HMO
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
Medicaid
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
Medicare Part A
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
Medicare Part B
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
POS
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
PPO
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
united healthcare
Workers Comp
O
75.38
17.22
81.88
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
EPO
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
HMO
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
Medicaid
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
Medicare Part A
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
Medicare Part B
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
POS
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
PPO
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3370
null
cpt
vancomycin hcl injection
va
Workers Comp
O
75.38
17.22
67.59
84.24
45.23


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
EPO
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
HMO
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
Medicaid
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
Medicare Part A
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
Medicare Part B
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
POS
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
PPO
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3411
null
cpt
thiamine hcl 100 mg
blue cross blue shield
Workers Comp
O
5.26
0.43
0.43
0.43
3.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
EPO
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
HMO
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
Medicaid
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
Medicare Part A
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
Medicare Part B
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
POS
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
PPO
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
aetna
Workers Comp
O
4.45
1.08
20.47
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
EPO
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
HMO
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
Medicaid
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
Medicare Part A
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
Medicare Part B
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
POS
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
PPO
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield
Workers Comp
O
4.45
1.08
1.08
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
EPO
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
HMO
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
Medicaid
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
Medicare Part A
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
Medicare Part B
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
POS
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
PPO
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
blue cross blue shield - medicare advantage
Workers Comp
O
4.45
1.08
1.23
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
EPO
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
HMO
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
Medicaid
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
Medicare Part A
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
Medicare Part B
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
POS
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
PPO
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
cigna
Workers Comp
O
4.45
1.08
12.25
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
EPO
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
HMO
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
Medicaid
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
Medicare Part A
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
Medicare Part B
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
POS
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
PPO
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3475
null
cpt
inj magnesium sulfate
united healthcare
Workers Comp
O
4.45
1.08
3.18
20.47
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
EPO
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
HMO
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
Medicaid
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
Medicare Part A
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
Medicare Part B
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
POS
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
PPO
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
aetna
Workers Comp
O
2.22
0.80
10.21
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
EPO
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
HMO
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
Medicaid
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
Medicare Part A
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
Medicare Part B
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
POS
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
PPO
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
blue cross blue shield
Workers Comp
O
2.22
0.80
0.80
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
EPO
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
HMO
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
Medicaid
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
Medicare Part A
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
Medicare Part B
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
POS
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
PPO
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3480
null
cpt
inj potassium chloride
united healthcare
Workers Comp
O
2.22
0.80
1.59
10.21
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
EPO
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
HMO
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
Medicaid
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
Medicare Part A
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
Medicare Part B
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
POS
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
PPO
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
aetna
Workers Comp
O
131.33
13.29
13.29
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
EPO
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
HMO
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
Medicaid
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
Medicare Part A
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
Medicare Part B
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
POS
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
PPO
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield
Workers Comp
O
131.33
13.29
43.18
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
EPO
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
HMO
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
Medicaid
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
Medicare Part A
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
Medicare Part B
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
POS
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
PPO
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3489
null
cpt
zoledronic acid 1mg
blue cross blue shield - medicare advantage
Workers Comp
O
131.33
13.29
44.94
44.94
78.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
EPO
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
HMO
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
Medicaid
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
Medicare Part A
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
Medicare Part B
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
POS
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
PPO
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield
Workers Comp
O
79.41
0.68
26.04
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
EPO
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
HMO
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
Medicaid
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
Medicare Part A
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
Medicare Part B
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
POS
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
PPO
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
blue cross blue shield - medicare advantage
Workers Comp
O
79.41
0.68
0.68
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
EPO
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
HMO
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
Medicaid
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
Medicare Part A
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
Medicare Part B
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
POS
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
PPO
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
geha
Workers Comp
O
79.41
0.68
61.60
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
EPO
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
HMO
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
Medicaid
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
Medicare Part A
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
Medicare Part B
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
POS
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
PPO
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
humana - medicare advantage
Workers Comp
O
79.41
0.68
1.39
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
EPO
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
HMO
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
Medicaid
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
Medicare Part A
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
Medicare Part B
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
POS
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
PPO
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
united healthcare
Workers Comp
O
79.41
0.68
91.70
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
EPO
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
HMO
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
Medicaid
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
Medicare Part A
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
Medicare Part B
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
POS
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
PPO
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J3490
null
cpt
drugs unclassified injection
va
Workers Comp
O
79.41
0.68
2.22
91.70
47.65


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
EPO
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
HMO
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
Medicaid
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
Medicare Part A
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
Medicare Part B
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
POS
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
PPO
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
aetna
Workers Comp
O
7.79
2.59
40.05
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
EPO
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
HMO
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
Medicaid
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part A
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part B
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
POS
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
PPO
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield
Workers Comp
O
7.79
2.59
5.60
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
EPO
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
HMO
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicaid
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part A
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part B
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
POS
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
PPO
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Workers Comp
O
7.79
2.59
36.92
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
EPO
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
HMO
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
Medicaid
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
Medicare Part A
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
Medicare Part B
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
POS
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
PPO
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
united healthcare
Workers Comp
O
7.79
2.59
5.57
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
EPO
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
HMO
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
Medicaid
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
Medicare Part A
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
Medicare Part B
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
POS
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
PPO
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7030
null
cpt
normal saline solution infus
va
Workers Comp
O
7.79
2.59
2.59
40.05
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
EPO
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
HMO
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
Medicaid
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
Medicare Part A
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
Medicare Part B
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
POS
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
PPO
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
aetna
Workers Comp
O
157.91
21.28
72.64
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
EPO
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
HMO
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
Medicaid
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part A
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part B
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
POS
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
PPO
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield
Workers Comp
O
157.91
21.28
69.61
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
EPO
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
HMO
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicaid
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part A
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part B
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
POS
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
PPO
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Workers Comp
O
157.91
21.28
71.71
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
EPO
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
HMO
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
Medicaid
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
Medicare Part A
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
Medicare Part B
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
POS
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
PPO
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
cigna
Workers Comp
O
157.91
21.28
122.44
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
EPO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
HMO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
Medicaid
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
Medicare Part A
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
Medicare Part B
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
POS
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
PPO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
geha
Workers Comp
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
EPO
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
HMO
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
Medicaid
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
Medicare Part A
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
Medicare Part B
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
POS
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
PPO
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
healthchoice
Workers Comp
O
157.91
21.28
21.28
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
EPO
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
HMO
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
Medicaid
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
Medicare Part A
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
Medicare Part B
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
POS
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
PPO
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
medica
Workers Comp
O
157.91
21.28
58.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
EPO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
HMO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
Medicaid
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
Medicare Part A
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
Medicare Part B
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
POS
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
PPO
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
united healthcare
Workers Comp
O
157.91
21.28
118.43
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
EPO
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
HMO
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
Medicaid
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
Medicare Part A
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
Medicare Part B
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
POS
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
PPO
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7040
null
cpt
normal saline solution infus
va
Workers Comp
O
157.91
21.28
157.91
157.91
94.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
EPO
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
HMO
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
Medicaid
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
Medicare Part A
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
Medicare Part B
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
POS
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
PPO
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7042
null
cpt
5% dextrose/normal saline
blue cross blue shield - medicare advantage
Workers Comp
O
164.69
60.14
60.14
60.14
98.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
EPO
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
HMO
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
Medicaid
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
Medicare Part A
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
Medicare Part B
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
POS
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
PPO
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
aetna
Workers Comp
O
157.33
63.87
75.05
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
EPO
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
HMO
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
Medicaid
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part A
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
Medicare Part B
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
POS
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
PPO
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield
Workers Comp
O
157.33
63.87
63.87
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
EPO
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
HMO
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicaid
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part A
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Medicare Part B
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
POS
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
PPO
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
blue cross blue shield - medicare advantage
Workers Comp
O
157.33
63.87
72.47
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
EPO
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
HMO
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
Medicaid
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
Medicare Part A
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
Medicare Part B
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
POS
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
PPO
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7050
null
cpt
normal saline solution infus
va
Workers Comp
O
157.33
63.87
157.33
157.33
94.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
EPO
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
HMO
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
Medicaid
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
Medicare Part A
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
Medicare Part B
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
POS
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
PPO
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7070
null
cpt
d5w infusion
blue cross blue shield - medicare advantage
Workers Comp
O
158.48
35.83
35.83
35.83
95.09


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
EPO
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
HMO
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
Medicaid
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
Medicare Part A
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
Medicare Part B
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
POS
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
PPO
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
aetna
Workers Comp
O
162.48
2.68
74.74
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
EPO
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
HMO
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
Medicaid
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
Medicare Part A
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
Medicare Part B
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
POS
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
PPO
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield
Workers Comp
O
162.48
2.68
59.77
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
EPO
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
HMO
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
Medicaid
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
Medicare Part A
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
Medicare Part B
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
POS
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
PPO
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
blue cross blue shield - medicare advantage
Workers Comp
O
162.48
2.68
39.22
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
EPO
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
HMO
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
Medicaid
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
Medicare Part A
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
Medicare Part B
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
POS
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
PPO
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
cigna
Workers Comp
O
162.48
2.68
113.90
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
EPO
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
HMO
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
Medicaid
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
Medicare Part A
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
Medicare Part B
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
POS
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
PPO
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
humana - medicare advantage
Workers Comp
O
162.48
2.68
2.68
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
EPO
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
HMO
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
Medicaid
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
Medicare Part A
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
Medicare Part B
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
POS
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
PPO
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
united healthcare
Workers Comp
O
162.48
2.68
121.86
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
EPO
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
HMO
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
Medicaid
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
Medicare Part A
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
Medicare Part B
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
POS
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
PPO
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7120
null
cpt
ringers lactate infusion
va
Workers Comp
O
162.48
2.68
162.48
162.48
97.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
EPO
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
HMO
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
Medicaid
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
Medicare Part A
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
Medicare Part B
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
POS
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
PPO
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7121
null
cpt
5% dextrose in lac ringers
blue cross blue shield - medicare advantage
Workers Comp
O
165.37
36.57
36.57
36.57
99.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
EPO
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
HMO
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
Medicaid
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
Medicare Part A
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
Medicare Part B
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
POS
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
PPO
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J7512
null
cpt
prednisone ir or dr oral 1mg
blue cross blue shield
Workers Comp
O
0.11
0.02
0.02
0.02
0.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
EPO
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
HMO
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
Medicaid
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
Medicare Part A
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
Medicare Part B
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
POS
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
PPO
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield
Workers Comp
O
21.51
4.86
8.43
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
EPO
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
HMO
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
Medicaid
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
Medicare Part A
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
Medicare Part B
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
POS
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
PPO
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J8501
null
cpt
oral aprepitant
blue cross blue shield - medicare advantage
Workers Comp
O
21.51
4.86
4.86
8.43
12.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
EPO
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
HMO
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
Medicaid
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
Medicare Part A
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
Medicare Part B
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
POS
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
PPO
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
aetna
Workers Comp
O
10.01
1.54
27.00
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
EPO
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
HMO
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
Medicaid
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
Medicare Part A
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
Medicare Part B
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
POS
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
PPO
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield
Workers Comp
O
10.01
1.54
2.08
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
EPO
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
HMO
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
Medicaid
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
Medicare Part A
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
Medicare Part B
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
POS
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
PPO
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9000
null
cpt
doxorubicin hcl injection
blue cross blue shield - medicare advantage
Workers Comp
O
10.01
1.54
1.54
27.00
6.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
EPO
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
HMO
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
Medicaid
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
Medicare Part A
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
Medicare Part B
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
POS
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
PPO
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
blue cross blue shield
Workers Comp
O
139.12
58.34
74.75
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
EPO
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
HMO
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
Medicaid
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
Medicare Part A
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
Medicare Part B
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
POS
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
PPO
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9022
null
cpt
inj atezolizumab10 mg
humana - medicare advantage
Workers Comp
O
139.12
58.34
58.34
74.75
83.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
EPO
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
HMO
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
Medicaid
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
Medicare Part A
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
Medicare Part B
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
POS
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
PPO
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9023
null
cpt
injection avelumab 10 mg
humana - medicare advantage
Workers Comp
O
319.43
62.39
62.39
62.39
191.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
EPO
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
HMO
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
Medicaid
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
Medicare Part A
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
Medicare Part B
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
POS
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
PPO
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna
Workers Comp
O
508.80
0.68
197.54
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
EPO
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
HMO
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
Medicaid
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
Medicare Part A
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
Medicare Part B
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
POS
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
PPO
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
aetna - medicare advantage
Workers Comp
O
508.80
0.68
133.06
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
EPO
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
HMO
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
Medicaid
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
Medicare Part A
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
Medicare Part B
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
POS
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
PPO
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
blue cross blue shield
Workers Comp
O
508.80
0.68
1.38
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
EPO
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
HMO
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
Medicaid
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
Medicare Part A
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
Medicare Part B
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
POS
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
PPO
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9025
null
cpt
azacitidine injection
humana - medicare advantage
Workers Comp
O
508.80
0.68
0.68
197.54
305.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
EPO
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
HMO
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
Medicaid
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
Medicare Part A
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
Medicare Part B
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
POS
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
PPO
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
tricare
Workers Comp
O
94.38
19.65
19.65
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
EPO
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
HMO
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
Medicaid
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
Medicare Part A
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
Medicare Part B
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
POS
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
PPO
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9034
null
cpt
inj. bendeka 1 mg
united healthcare
Workers Comp
O
94.38
19.65
8872.20
8872.20
56.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
EPO
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
HMO
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
Medicaid
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
Medicare Part A
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
Medicare Part B
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
POS
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
PPO
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
aetna
Workers Comp
O
1346.20
58.02
3873.00
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
EPO
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
HMO
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
Medicaid
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
Medicare Part A
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
Medicare Part B
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
POS
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
PPO
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
blue cross blue shield
Workers Comp
O
1346.20
58.02
81.94
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
EPO
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
HMO
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
Medicaid
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
Medicare Part A
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
Medicare Part B
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
POS
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
PPO
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
humana - medicare advantage
Workers Comp
O
1346.20
58.02
58.02
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
EPO
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
HMO
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
Medicaid
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
Medicare Part A
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
Medicare Part B
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
POS
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
PPO
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
tricare
Workers Comp
O
1346.20
58.02
79.56
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
EPO
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
HMO
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
Medicaid
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
Medicare Part A
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
Medicare Part B
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
POS
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
PPO
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9035
null
cpt
bevacizumab injection
united healthcare
Workers Comp
O
1346.20
58.02
22212.30
22212.30
807.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
EPO
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
HMO
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
Medicaid
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
Medicare Part A
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
Medicare Part B
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
POS
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
PPO
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
aetna
Workers Comp
O
821.38
58.25
58.25
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
EPO
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
HMO
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
Medicaid
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
Medicare Part A
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
Medicare Part B
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
POS
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
PPO
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9040
null
cpt
bleomycin sulfate injection
blue cross blue shield
Workers Comp
O
821.38
58.25
85.34
85.34
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
EPO
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
HMO
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
Medicaid
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
Medicare Part A
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
Medicare Part B
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
POS
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
PPO
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
aetna
Workers Comp
O
1450.08
32.02
32.02
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
EPO
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
HMO
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
Medicaid
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
Medicare Part A
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
Medicare Part B
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
POS
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
PPO
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
blue cross blue shield
Workers Comp
O
1450.08
32.02
134.79
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
EPO
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
HMO
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
Medicaid
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
Medicare Part A
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
Medicare Part B
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
POS
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
PPO
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9041
null
cpt
inj. velcade 0.1 mg
humana - medicare advantage
Workers Comp
O
1450.08
32.02
620.48
620.48
870.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
EPO
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
HMO
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
Medicaid
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
Medicare Part A
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
Medicare Part B
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
POS
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
PPO
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
blue cross blue shield - medicare advantage
Workers Comp
O
462.16
137.63
137.63
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
EPO
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
HMO
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
Medicaid
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
Medicare Part A
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
Medicare Part B
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
POS
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
PPO
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9042
null
cpt
brentuximab vedotin inj
tricare
Workers Comp
O
462.16
137.63
169.37
169.37
277.30


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
EPO
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
HMO
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
Medicaid
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
Medicare Part A
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
Medicare Part B
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
POS
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
PPO
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
aetna
Workers Comp
O
15.58
4.66
45.75
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
EPO
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
HMO
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
Medicaid
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
Medicare Part A
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
Medicare Part B
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
POS
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
PPO
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield
Workers Comp
O
15.58
4.66
4.71
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
EPO
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
HMO
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
Medicaid
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
Medicare Part A
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
Medicare Part B
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
POS
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
PPO
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9045
null
cpt
carboplatin injection
blue cross blue shield - medicare advantage
Workers Comp
O
15.58
4.66
4.66
45.75
9.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
EPO
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
HMO
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
Medicaid
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
Medicare Part A
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
Medicare Part B
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
POS
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
PPO
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
blue cross blue shield
Workers Comp
O
1038.80
33.95
33.95
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
EPO
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
HMO
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
Medicaid
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
Medicare Part A
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
Medicare Part B
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
POS
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
PPO
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
tricare
Workers Comp
O
1038.80
33.95
64.29
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
EPO
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
HMO
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
Medicaid
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
Medicare Part A
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
Medicare Part B
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
POS
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
PPO
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9055
null
cpt
cetuximab injection
va
Workers Comp
O
1038.80
33.95
6650.85
6650.85
623.28


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
EPO
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
HMO
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
Medicaid
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
Medicare Part A
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
Medicare Part B
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
POS
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
PPO
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
aetna
Workers Comp
O
8.25
2.81
14.68
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
EPO
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
HMO
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
Medicaid
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
Medicare Part A
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
Medicare Part B
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
POS
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
PPO
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
blue cross blue shield
Workers Comp
O
8.25
2.81
2.81
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
EPO
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
HMO
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
Medicaid
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
Medicare Part A
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
Medicare Part B
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
POS
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
PPO
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9060
null
cpt
cisplatin 10 mg injection
united healthcare
Workers Comp
O
8.25
2.81
128.00
128.00
4.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
EPO
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
HMO
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
Medicaid
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
Medicare Part A
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
Medicare Part B
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
POS
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
PPO
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield
Workers Comp
O
856.48
34.49
44.86
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
EPO
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
HMO
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
Medicaid
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
Medicare Part A
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
Medicare Part B
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
POS
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
PPO
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
blue cross blue shield - medicare advantage
Workers Comp
O
856.48
34.49
34.49
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
EPO
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
HMO
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
Medicaid
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
Medicare Part A
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
Medicare Part B
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
POS
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
PPO
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
tricare
Workers Comp
O
856.48
34.49
34.57
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
EPO
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
HMO
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
Medicaid
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
Medicare Part A
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
Medicare Part B
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
POS
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
PPO
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9070
null
cpt
cyclophosphamide 100 mg inj
united healthcare
Workers Comp
O
856.48
34.49
160.59
160.59
513.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
EPO
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
HMO
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
Medicaid
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
Medicare Part A
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
Medicare Part B
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
POS
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
PPO
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9119
null
cpt
inj. cemiplimab-rwlc 1 mg
blue cross blue shield
Workers Comp
O
73.50
17.92
17.92
17.92
44.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
EPO
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
HMO
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
Medicaid
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
Medicare Part A
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
Medicare Part B
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
POS
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
PPO
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
aetna
Workers Comp
O
124.64
3.32
40.20
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
EPO
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
HMO
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
Medicaid
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
Medicare Part A
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
Medicare Part B
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
POS
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
PPO
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9130
null
cpt
dacarbazine 100 mg inj
blue cross blue shield
Workers Comp
O
124.64
3.32
3.32
40.20
74.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
EPO
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
HMO
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
Medicaid
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
Medicare Part A
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
Medicare Part B
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
POS
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
PPO
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
aetna
Workers Comp
O
139.92
43.32
43.85
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
EPO
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
HMO
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
Medicaid
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
Medicare Part A
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
Medicare Part B
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
POS
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
PPO
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
blue cross blue shield
Workers Comp
O
139.92
43.32
43.32
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
EPO
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
HMO
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
Medicaid
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
Medicare Part A
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
Medicare Part B
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
POS
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
PPO
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9144
null
cpt
daratumumab hyaluronidase
va
Workers Comp
O
139.92
43.32
45.12
45.12
83.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
EPO
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
HMO
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
Medicaid
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
Medicare Part A
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
Medicare Part B
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
POS
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
PPO
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9145
null
cpt
injection daratumumab 10 mg
aetna
Workers Comp
O
439.60
56.06
56.06
56.06
263.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
EPO
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
HMO
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
Medicaid
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
Medicare Part A
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
Medicare Part B
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
POS
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
PPO
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
aetna
Workers Comp
O
155.80
0.85
109.20
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
EPO
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
HMO
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
Medicaid
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
Medicare Part A
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
Medicare Part B
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
POS
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
PPO
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield
Workers Comp
O
155.80
0.85
3.32
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
EPO
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
HMO
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
Medicaid
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
Medicare Part A
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
Medicare Part B
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
POS
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
PPO
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
blue cross blue shield - medicare advantage
Workers Comp
O
155.80
0.85
4.18
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
EPO
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
HMO
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
Medicaid
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
Medicare Part A
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
Medicare Part B
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
POS
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
PPO
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
humana - medicare advantage
Workers Comp
O
155.80
0.85
0.87
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
EPO
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
HMO
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
Medicaid
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
Medicare Part A
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
Medicare Part B
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
POS
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
PPO
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9171
null
cpt
docetaxel injection
tricare
Workers Comp
O
155.80
0.85
0.85
109.20
93.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
EPO
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
HMO
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
Medicaid
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
Medicare Part A
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
Medicare Part B
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
POS
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
PPO
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield
Workers Comp
O
252.65
49.93
65.99
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
EPO
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
HMO
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
POS
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
PPO
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
252.65
49.93
49.93
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
EPO
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
HMO
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
Medicaid
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
Medicare Part A
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
Medicare Part B
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
POS
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
PPO
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9173
null
cpt
inj. durvalumab 10 mg
va
Workers Comp
O
252.65
49.93
76.86
76.86
151.59


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
EPO
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
HMO
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
Medicaid
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
Medicare Part A
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
Medicare Part B
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
POS
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
PPO
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
blue cross blue shield - medicare advantage
Workers Comp
O
412.92
108.87
108.87
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
EPO
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
HMO
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
Medicaid
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
Medicare Part A
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
Medicare Part B
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
POS
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
PPO
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
tricare
Workers Comp
O
412.92
108.87
123.93
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
EPO
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
HMO
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
Medicaid
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
Medicare Part A
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
Medicare Part B
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
POS
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
PPO
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9179
null
cpt
eribulin mesylate injection
united healthcare
Workers Comp
O
412.92
108.87
309.69
309.69
247.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
EPO
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
HMO
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
Medicaid
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
Medicare Part A
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
Medicare Part B
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
POS
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
PPO
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9181
null
cpt
etoposide injection
blue cross blue shield
Workers Comp
O
3.33
1.27
1.27
1.27
2.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
EPO
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
HMO
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
Medicaid
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
Medicare Part A
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
Medicare Part B
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
POS
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
PPO
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
aetna
Workers Comp
O
7.79
1.84
14.85
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
EPO
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
HMO
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
Medicaid
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
Medicare Part A
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
Medicare Part B
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
POS
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
PPO
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield
Workers Comp
O
7.79
1.84
1.84
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
EPO
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
HMO
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
Medicaid
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
Medicare Part A
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
Medicare Part B
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
POS
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
PPO
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
blue cross blue shield - medicare advantage
Workers Comp
O
7.79
1.84
2.62
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
EPO
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
HMO
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
Medicaid
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
Medicare Part A
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
Medicare Part B
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
POS
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
PPO
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
cigna
Workers Comp
O
7.79
1.84
5.20
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
EPO
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
HMO
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
Medicaid
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
Medicare Part A
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
Medicare Part B
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
POS
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
PPO
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9190
null
cpt
fluorouracil injection
united healthcare
Workers Comp
O
7.79
1.84
5.57
14.85
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
EPO
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
HMO
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
Medicaid
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
Medicare Part A
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
Medicare Part B
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
POS
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
PPO
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
blue cross blue shield
Workers Comp
O
33.39
11.65
11.65
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
EPO
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
HMO
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
Medicaid
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
Medicare Part A
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
Medicare Part B
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
POS
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
PPO
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9201
null
cpt
in gemcitabine hcl nos 200mg
united healthcare
Workers Comp
O
33.39
11.65
23.85
23.85
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
EPO
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
HMO
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
Medicaid
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
Medicare Part A
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
Medicare Part B
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
POS
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
PPO
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
aetna
Workers Comp
O
1141.93
149.56
574.16
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
EPO
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
HMO
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
Medicaid
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
Medicare Part A
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
Medicare Part B
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
POS
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
PPO
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
blue cross blue shield
Workers Comp
O
1141.93
149.56
149.56
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
EPO
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
HMO
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
Medicaid
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
Medicare Part A
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
Medicare Part B
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
POS
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
PPO
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9202
null
cpt
goserelin acetate implant
united healthcare
Workers Comp
O
1141.93
149.56
815.67
815.67
685.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
EPO
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
HMO
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
Medicaid
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
Medicare Part A
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
Medicare Part B
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
POS
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
PPO
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield
Workers Comp
O
14.46
4.19
4.19
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
EPO
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
HMO
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
Medicaid
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
Medicare Part A
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
Medicare Part B
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
POS
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
PPO
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9206
null
cpt
irinotecan injection
blue cross blue shield - medicare advantage
Workers Comp
O
14.46
4.19
5.21
5.21
8.68


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
EPO
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
HMO
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
Medicaid
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
Medicare Part A
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
Medicare Part B
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
POS
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
PPO
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
blue cross blue shield
Workers Comp
O
897.07
155.45
155.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
EPO
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
HMO
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
Medicaid
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
Medicare Part A
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
Medicare Part B
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
POS
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
PPO
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
humana - medicare advantage
Workers Comp
O
897.07
155.45
224.45
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
EPO
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
HMO
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
Medicaid
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
Medicare Part A
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
Medicare Part B
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
POS
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
PPO
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
tricare
Workers Comp
O
897.07
155.45
230.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
EPO
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
HMO
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
Medicaid
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
Medicare Part A
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
Medicare Part B
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
POS
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
PPO
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare
Workers Comp
O
897.07
155.45
640.77
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
EPO
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
HMO
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
Medicaid
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
Medicare Part A
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
Medicare Part B
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
POS
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
PPO
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
united healthcare - medicare advantage
Workers Comp
O
897.07
155.45
226.39
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
EPO
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
HMO
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
Medicaid
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
Medicare Part A
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
Medicare Part B
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
POS
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
PPO
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9217
null
cpt
leuprolide acetate suspnsion
va
Workers Comp
O
897.07
155.45
204.07
640.77
538.24


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
EPO
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
HMO
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
Medicaid
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
Medicare Part A
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
Medicare Part B
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
POS
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
PPO
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
aetna
Workers Comp
O
8991.98
104.37
157.23
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
EPO
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
HMO
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
Medicaid
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
Medicare Part A
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
Medicare Part B
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
POS
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
PPO
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield
Workers Comp
O
8991.98
104.37
146.41
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
EPO
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
HMO
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
Medicaid
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
Medicare Part A
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
Medicare Part B
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
POS
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
PPO
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9228
null
cpt
ipilimumab injection
blue cross blue shield - medicare advantage
Workers Comp
O
8991.98
104.37
104.37
157.23
5395.19


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
EPO
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
HMO
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicaid
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicare Part A
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicare Part B
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
POS
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
PPO
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9250
null
cpt
methotrexate sodium inj
blue cross blue shield
Workers Comp
O
2.35
0.47
0.47
0.47
1.41


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
EPO
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
HMO
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
Medicaid
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
Medicare Part A
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
Medicare Part B
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
POS
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
PPO
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
aetna
Workers Comp
O
10.61
2.14
3.88
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
EPO
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
HMO
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicaid
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicare Part A
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
Medicare Part B
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
POS
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
PPO
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield
Workers Comp
O
10.61
2.14
2.14
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
EPO
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
HMO
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
Medicaid
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
Medicare Part A
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
Medicare Part B
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
POS
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
PPO
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
blue cross blue shield - medicare advantage
Workers Comp
O
10.61
2.14
119.53
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
EPO
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
HMO
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
Medicaid
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
Medicare Part A
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
Medicare Part B
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
POS
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
PPO
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9260
null
cpt
methotrexate sodium inj
united healthcare
Workers Comp
O
10.61
2.14
10.74
119.53
6.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
EPO
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
HMO
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
Medicaid
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
Medicare Part A
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
Medicare Part B
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
POS
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
PPO
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
aetna
Workers Comp
O
7.79
1.85
39.00
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
EPO
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
HMO
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
Medicaid
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
Medicare Part A
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
Medicare Part B
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
POS
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
PPO
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
blue cross blue shield
Workers Comp
O
7.79
1.85
1.85
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
EPO
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
HMO
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
Medicaid
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
Medicare Part A
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
Medicare Part B
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
POS
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
PPO
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9263
null
cpt
oxaliplatin
cigna
Workers Comp
O
7.79
1.85
5.20
39.00
4.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
EPO
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
HMO
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
Medicaid
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
Medicare Part A
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
Medicare Part B
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
POS
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
PPO
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield
Workers Comp
O
2059.00
11.12
11.27
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
EPO
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
HMO
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
Medicaid
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
Medicare Part A
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
Medicare Part B
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
POS
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
PPO
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
blue cross blue shield - medicare advantage
Workers Comp
O
2059.00
11.12
11.12
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
EPO
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
HMO
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
Medicaid
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
Medicare Part A
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
Medicare Part B
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
POS
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
PPO
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
tricare
Workers Comp
O
2059.00
11.12
13.30
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
EPO
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
HMO
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
Medicaid
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
Medicare Part A
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
Medicare Part B
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
POS
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
PPO
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9264
null
cpt
paclitaxel protein bound
united healthcare
Workers Comp
O
2059.00
11.12
2956.95
2956.95
1235.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
EPO
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
HMO
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
Medicaid
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
Medicare Part A
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
Medicare Part B
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
POS
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
PPO
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield
Workers Comp
O
4.45
0.95
0.99
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
EPO
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
HMO
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
Medicaid
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
Medicare Part A
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
Medicare Part B
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
POS
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
PPO
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9267
null
cpt
paclitaxel injection
blue cross blue shield - medicare advantage
Workers Comp
O
4.45
0.95
0.95
0.99
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
EPO
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
HMO
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
Medicaid
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
Medicare Part A
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
Medicare Part B
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
POS
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
PPO
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield
Workers Comp
O
181.41
31.90
42.41
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
EPO
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
HMO
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
Medicaid
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
Medicare Part A
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
Medicare Part B
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
POS
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
PPO
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
blue cross blue shield - medicare advantage
Workers Comp
O
181.41
31.90
31.90
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
EPO
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
HMO
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
Medicaid
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
Medicare Part A
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
Medicare Part B
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
POS
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
PPO
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
cigna
Workers Comp
O
181.41
31.90
128.38
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
EPO
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
HMO
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
Medicaid
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
Medicare Part A
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
Medicare Part B
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
POS
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
PPO
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
humana - medicare advantage
Workers Comp
O
181.41
31.90
37.36
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
EPO
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
HMO
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
Medicaid
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
Medicare Part A
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
Medicare Part B
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
POS
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
PPO
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare
Workers Comp
O
181.41
31.90
129.59
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
EPO
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
HMO
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
Medicaid
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
Medicare Part A
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
Medicare Part B
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
POS
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
PPO
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
united healthcare - medicare advantage
Workers Comp
O
181.41
31.90
49.28
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
EPO
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
HMO
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
Medicaid
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
Medicare Part A
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
Medicare Part B
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
POS
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
PPO
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9271
null
cpt
inj pembrolizumab
va
Workers Comp
O
181.41
31.90
50.26
129.59
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
EPO
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
HMO
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
Medicaid
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
Medicare Part A
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
Medicare Part B
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
POS
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
PPO
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
aetna
Workers Comp
O
101.28
13.00
28.54
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
EPO
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
HMO
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
Medicaid
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
Medicare Part A
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
Medicare Part B
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
POS
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
PPO
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield
Workers Comp
O
101.28
13.00
15.47
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
EPO
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
HMO
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
Medicaid
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
Medicare Part A
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
Medicare Part B
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
POS
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
PPO
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
blue cross blue shield - medicare advantage
Workers Comp
O
101.28
13.00
13.00
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
EPO
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
HMO
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
Medicaid
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
Medicare Part A
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
Medicare Part B
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
POS
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
PPO
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9299
null
cpt
injection nivolumab
humana - medicare advantage
Workers Comp
O
101.28
13.00
2485.25
2485.25
60.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
EPO
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
HMO
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
Medicaid
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
Medicare Part A
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
Medicare Part B
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
POS
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
PPO
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
aetna - medicare advantage
Workers Comp
O
21836.00
44.88
4612.07
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
EPO
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
HMO
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
Medicaid
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
Medicare Part A
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
Medicare Part B
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
POS
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
PPO
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
blue cross blue shield
Workers Comp
O
21836.00
44.88
44.88
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
EPO
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
HMO
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
Medicaid
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
Medicare Part A
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
Medicare Part B
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
POS
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
PPO
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
tricare
Workers Comp
O
21836.00
44.88
64.19
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
EPO
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
HMO
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
Medicaid
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
Medicare Part A
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
Medicare Part B
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
POS
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
PPO
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9301
null
cpt
obinutuzumab inj
va
Workers Comp
O
21836.00
44.88
64.54
4612.07
13101.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
EPO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
HMO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
Medicaid
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
Medicare Part A
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
Medicare Part B
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
POS
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
PPO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield
Workers Comp
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
EPO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
HMO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
Medicaid
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
Medicare Part A
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
Medicare Part B
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
POS
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
PPO
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9303
null
cpt
panitumumab injection
blue cross blue shield - medicare advantage
Workers Comp
O
15089.10
118.89
118.89
118.89
9053.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
EPO
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
HMO
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
Medicaid
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
Medicare Part A
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
Medicare Part B
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
POS
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
PPO
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
blue cross blue shield
Workers Comp
O
1662.08
52.94
64.77
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
EPO
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
HMO
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
Medicaid
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
Medicare Part A
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
Medicare Part B
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
POS
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
PPO
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
humana - medicare advantage
Workers Comp
O
1662.08
52.94
52.94
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
EPO
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
HMO
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
Medicaid
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
Medicare Part A
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
Medicare Part B
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
POS
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
PPO
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
tricare
Workers Comp
O
1662.08
52.94
71.81
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
EPO
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
HMO
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
Medicaid
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
Medicare Part A
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
Medicare Part B
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
POS
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
PPO
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9305
null
cpt
inj. pemetrexed nos 10mg
va
Workers Comp
O
1662.08
52.94
5994.32
5994.32
997.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
EPO
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
HMO
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
Medicaid
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
Medicare Part A
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
Medicare Part B
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
POS
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
PPO
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
aetna
Workers Comp
O
42.29
10.62
5145.00
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
EPO
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
HMO
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
Medicaid
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
Medicare Part A
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
Medicare Part B
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
POS
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
PPO
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield
Workers Comp
O
42.29
10.62
11.64
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
EPO
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
HMO
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
Medicaid
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
POS
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
PPO
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
blue cross blue shield - medicare advantage
Workers Comp
O
42.29
10.62
10.62
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
EPO
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
HMO
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
Medicaid
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
Medicare Part A
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
Medicare Part B
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
POS
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
PPO
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9306
null
cpt
injection pertuzumab 1 mg
tricare
Workers Comp
O
42.29
10.62
12.46
5145.00
25.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
EPO
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
HMO
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
Medicaid
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
Medicare Part A
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
Medicare Part B
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
POS
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
PPO
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield
Workers Comp
O
20776.00
29.77
34.67
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
EPO
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
HMO
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
Medicaid
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
Medicare Part A
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
Medicare Part B
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
POS
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
PPO
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
blue cross blue shield - medicare advantage
Workers Comp
O
20776.00
29.77
29.77
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
EPO
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
HMO
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
Medicaid
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
Medicare Part A
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
Medicare Part B
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
POS
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
PPO
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
humana - medicare advantage
Workers Comp
O
20776.00
29.77
42.66
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
EPO
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
HMO
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
Medicaid
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
Medicare Part A
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
Medicare Part B
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
POS
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
PPO
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
tricare
Workers Comp
O
20776.00
29.77
40.23
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
EPO
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
HMO
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
Medicaid
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
Medicare Part A
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
Medicare Part B
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
POS
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
PPO
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9311
null
cpt
inj rituximab hyaluronidase
united healthcare
Workers Comp
O
20776.00
29.77
111.30
111.30
12465.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
EPO
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
HMO
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
Medicaid
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
Medicare Part A
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
Medicare Part B
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
POS
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
PPO
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
tricare
Workers Comp
O
1515.80
91.26
91.26
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
EPO
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
HMO
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
Medicaid
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
Medicare Part A
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
Medicare Part B
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
POS
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
PPO
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9312
null
cpt
inj. rituximab 10 mg
united healthcare
Workers Comp
O
1515.80
91.26
13642.20
13642.20
909.48


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
EPO
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
HMO
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
Medicaid
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
Medicare Part A
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
Medicare Part B
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
POS
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
PPO
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9317
null
cpt
sacituzumab govitecan-hziy
blue cross blue shield - medicare advantage
Workers Comp
O
89.00
27.18
27.18
27.18
53.40


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
EPO
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
HMO
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
Medicaid
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
Medicare Part A
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
Medicare Part B
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
POS
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
PPO
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
aetna
Workers Comp
O
123.87
23.44
14762.00
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
EPO
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
HMO
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
Medicaid
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
Medicare Part A
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
Medicare Part B
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
POS
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
PPO
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
blue cross blue shield
Workers Comp
O
123.87
23.44
41.57
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
EPO
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
HMO
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
Medicaid
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
Medicare Part A
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
Medicare Part B
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
POS
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
PPO
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9354
null
cpt
inj ado-trastuzumab emt 1mg
humana - medicare advantage
Workers Comp
O
123.87
23.44
23.44
14762.00
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
EPO
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
HMO
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
Medicaid
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
Medicare Part A
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
Medicare Part B
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
POS
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
PPO
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
blue cross blue shield
Workers Comp
O
375.16
106.24
114.49
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
EPO
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
HMO
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
Medicaid
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
Medicare Part A
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
Medicare Part B
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
POS
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
PPO
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
tricare
Workers Comp
O
375.16
106.24
106.24
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
EPO
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
HMO
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
Medicaid
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
Medicare Part A
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
Medicare Part B
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
POS
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
PPO
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9355
null
cpt
inj trastuzumab excl biosimi
united healthcare
Workers Comp
O
375.16
106.24
252.81
252.81
225.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
EPO
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
HMO
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
Medicaid
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
Medicare Part A
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
Medicare Part B
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
POS
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
PPO
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9358
null
cpt
inj fam-trastu deru-nxki 1mg
aetna - medicare advantage
Workers Comp
O
1783.50
7239.00
7239.00
7239.00
1070.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
EPO
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
HMO
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
Medicaid
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
Medicare Part A
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
Medicare Part B
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
POS
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
PPO
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
aetna
Workers Comp
O
44.85
2.37
51.61
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
EPO
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
HMO
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
Medicaid
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
Medicare Part A
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
Medicare Part B
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
POS
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
PPO
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9360
null
cpt
vinblastine sulfate inj
blue cross blue shield
Workers Comp
O
44.85
2.37
2.37
51.61
26.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
EPO
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
HMO
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
Medicaid
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
Medicare Part A
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
Medicare Part B
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
POS
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
PPO
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9370
null
cpt
vincristine sulfate 1 mg inj
blue cross blue shield
Workers Comp
O
58.98
9.86
9.86
9.86
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
EPO
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
HMO
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
Medicaid
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
Medicare Part A
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
Medicare Part B
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
POS
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
PPO
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
aetna - medicare advantage
Workers Comp
O
375.08
40.04
83.26
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
EPO
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
HMO
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
Medicaid
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
Medicare Part A
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
Medicare Part B
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
POS
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
PPO
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield
Workers Comp
O
375.08
40.04
137.86
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
EPO
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
HMO
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
Medicaid
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
Medicare Part A
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
Medicare Part B
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
POS
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
PPO
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
blue cross blue shield - medicare advantage
Workers Comp
O
375.08
40.04
116.76
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
EPO
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
HMO
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
Medicaid
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
Medicare Part A
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
Medicare Part B
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
POS
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
PPO
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
humana - medicare advantage
Workers Comp
O
375.08
40.04
40.04
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
EPO
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
HMO
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
Medicaid
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
Medicare Part A
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
Medicare Part B
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
POS
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
PPO
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
tricare
Workers Comp
O
375.08
40.04
94.87
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
EPO
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
HMO
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
Medicaid
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
Medicare Part A
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
Medicare Part B
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
POS
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
PPO
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare
Workers Comp
O
375.08
40.04
267.92
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
EPO
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
HMO
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
Medicaid
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
Medicare Part A
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
Medicare Part B
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
POS
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
PPO
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
J9395
null
cpt
injection fulvestrant
united healthcare - medicare advantage
Workers Comp
O
375.08
40.04
88.12
267.92
225.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
EPO
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
HMO
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicaid
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part A
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part B
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
POS
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
PPO
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1830
null
cpt
ko immob canvas long pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Workers Comp
O
350.59
132.94
132.94
132.94
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
EPO
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
HMO
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicaid
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part A
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part B
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
POS
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
PPO
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Workers Comp
O
821.39
303.61
303.61
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
EPO
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
HMO
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
Medicaid
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
Medicare Part A
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
Medicare Part B
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
POS
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
PPO
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
geha
Workers Comp
O
821.39
303.61
586.71
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
EPO
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
HMO
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicaid
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part A
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part B
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
POS
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
PPO
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L1833
null
cpt
ko adj jnt pos r sup pre ots;; Prosthetics Orthotics and Supplies
tricare
Workers Comp
O
821.39
303.61
465.38
586.71
492.83


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
EPO
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
HMO
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
Medicaid
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
Medicare Part A
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
Medicare Part B
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
POS
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
PPO
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield
Workers Comp
O
302.73
82.09
105.05
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
EPO
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
HMO
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
Medicaid
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
Medicare Part A
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
Medicare Part B
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
POS
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
PPO
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3260
null
cpt
ambulatory surgical boot eac
blue cross blue shield - medicare advantage
Workers Comp
O
302.73
82.09
82.09
105.05
181.64


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
EPO
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
HMO
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicaid
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part A
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part B
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
POS
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
PPO
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Workers Comp
O
89.04
22.20
40.21
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
EPO
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
HMO
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicaid
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
POS
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
PPO
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
89.04
22.20
22.20
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
EPO
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
HMO
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicaid
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part A
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part B
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
POS
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
PPO
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3660
null
cpt
so 8 ab rstr can/web pre ots;; Prosthetics Orthotics and Supplies
tricare
Workers Comp
O
89.04
22.20
94.38
94.38
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
EPO
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
HMO
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicaid
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part A
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part B
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
POS
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
PPO
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield
Workers Comp
O
612.15
178.61
276.81
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
EPO
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
HMO
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicaid
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
POS
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
PPO
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3670
null
cpt
so acro/clav can web pre ots;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
612.15
178.61
178.61
276.81
367.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
EPO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
HMO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicaid
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicare Part A
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicare Part B
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
POS
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
PPO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Workers Comp
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
EPO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
HMO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicaid
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part A
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
Medicare Part B
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
POS
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
PPO
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L3925
null
cpt
fo pip dip jnt/sprng pre ots;; Prosthetics Orthotics and Supplies
tricare
Workers Comp
O
169.17
49.35
49.35
49.35
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
EPO
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
HMO
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicaid
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part A
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
Medicare Part B
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
POS
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
PPO
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield
Workers Comp
O
575.42
159.68
225.43
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
EPO
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
HMO
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicaid
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part A
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Medicare Part B
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
POS
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
PPO
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
575.42
159.68
160.01
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
EPO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
HMO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicaid
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicare Part A
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Medicare Part B
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
POS
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
PPO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
humana - medicare advantage
Workers Comp
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
EPO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
HMO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
Medicaid
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
Medicare Part A
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
Medicare Part B
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
POS
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
PPO
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L4386
null
cpt
non-pneum walk boot pre cst;; Prosthetics Orthotics and Supplies
tricare
Workers Comp
O
575.42
159.68
159.68
225.43
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
EPO
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
HMO
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
Medicaid
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
Medicare Part A
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
Medicare Part B
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
POS
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
PPO
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
L8680
null
cpt
implt neurostim elctr each
blue cross blue shield
Workers Comp
O
2502.02
1448.78
1448.78
1448.78
1501.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
EPO
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
HMO
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
Medicaid
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
Medicare Part A
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
Medicare Part B
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
POS
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
PPO
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
aetna
Workers Comp
O
960.00
138.89
502.86
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
EPO
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
HMO
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
Medicaid
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
Medicare Part A
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
Medicare Part B
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
POS
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
PPO
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield
Workers Comp
O
960.00
138.89
163.26
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
EPO
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
HMO
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
Medicaid
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
Medicare Part A
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
Medicare Part B
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
POS
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
PPO
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
blue cross blue shield - medicare advantage
Workers Comp
O
960.00
138.89
138.89
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
EPO
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
HMO
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
Medicaid
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
Medicare Part A
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
Medicare Part B
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
POS
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
PPO
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
M0243
null
cpt
casirivi and imdevi infusion
tricare
Workers Comp
O
960.00
138.89
398.98
502.86
576.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
EPO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
HMO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
Medicaid
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
Medicare Part A
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
Medicare Part B
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
POS
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
PPO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
aetna - medicare advantage
Workers Comp
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
EPO
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
HMO
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
Medicaid
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
Medicare Part A
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
Medicare Part B
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
POS
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
PPO
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield
Workers Comp
O
714.50
185.49
511.69
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
EPO
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
HMO
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
Medicaid
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
Medicare Part A
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
Medicare Part B
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
POS
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
PPO
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
blue cross blue shield - medicare advantage
Workers Comp
O
714.50
185.49
416.20
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
EPO
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
HMO
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
Medicaid
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
Medicare Part A
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
Medicare Part B
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
POS
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
PPO
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
humana - medicare advantage
Workers Comp
O
714.50
185.49
185.49
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
EPO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
HMO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
Medicaid
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
Medicare Part A
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
Medicare Part B
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
POS
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
PPO
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
tricare
Workers Comp
O
714.50
185.49
188.35
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
EPO
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
HMO
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
Medicaid
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
Medicare Part A
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
Medicare Part B
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
POS
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
PPO
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
united healthcare
Workers Comp
O
714.50
185.49
1071.75
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
EPO
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
HMO
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
Medicaid
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
Medicare Part A
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
Medicare Part B
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
POS
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
PPO
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9016
null
cpt
rbc leukocytes reduced
va
Workers Comp
O
714.50
185.49
282.77
1071.75
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
EPO
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
HMO
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
Medicaid
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
Medicare Part A
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
Medicare Part B
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
POS
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
PPO
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
blue cross blue shield - medicare advantage
Workers Comp
O
2868.20
324.02
1198.75
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
EPO
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
HMO
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
Medicaid
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
Medicare Part A
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
Medicare Part B
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
POS
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
PPO
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9034
null
cpt
platelets pheresis
tricare
Workers Comp
O
2868.20
324.02
324.02
1198.75
1720.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
EPO
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
HMO
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
Medicaid
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
Medicare Part A
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
Medicare Part B
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
POS
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
PPO
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9035
null
cpt
platelet pheres leukoreduced
blue cross blue shield - medicare advantage
Workers Comp
O
2.22
0.93
0.93
0.93
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
EPO
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
HMO
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
Medicaid
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
Medicare Part A
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
Medicare Part B
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
POS
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
PPO
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
aetna - medicare advantage
Workers Comp
O
3009.54
617.33
617.33
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
EPO
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
HMO
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
Medicaid
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
Medicare Part A
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
Medicare Part B
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
POS
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
PPO
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield
Workers Comp
O
3009.54
617.33
1348.78
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
EPO
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
HMO
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
Medicaid
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
Medicare Part A
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
Medicare Part B
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
POS
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
PPO
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
blue cross blue shield - medicare advantage
Workers Comp
O
3009.54
617.33
1111.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
EPO
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
HMO
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
Medicaid
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
Medicare Part A
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
Medicare Part B
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
POS
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
PPO
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
humana - medicare advantage
Workers Comp
O
3009.54
617.33
634.69
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
EPO
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
HMO
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
Medicaid
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
Medicare Part A
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
Medicare Part B
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
POS
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
PPO
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9037
null
cpt
plate pheres leukoredu irrad
va
Workers Comp
O
3009.54
617.33
1046.21
1348.78
1805.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
EPO
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
HMO
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
Medicaid
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
Medicare Part A
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
Medicare Part B
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
POS
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
PPO
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna
Workers Comp
O
713.43
261.66
394.14
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
EPO
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
HMO
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
Medicaid
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
Medicare Part A
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
Medicare Part B
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
POS
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
PPO
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
aetna - medicare advantage
Workers Comp
O
713.43
261.66
261.66
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
EPO
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
HMO
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
Medicaid
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
Medicare Part A
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
Medicare Part B
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
POS
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
PPO
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
blue cross blue shield - medicare advantage
Workers Comp
O
713.43
261.66
468.49
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
EPO
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
HMO
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
Medicaid
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
Medicare Part A
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
Medicare Part B
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
POS
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
PPO
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
humana - medicare advantage
Workers Comp
O
713.43
261.66
262.76
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
EPO
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
HMO
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
Medicaid
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
Medicare Part A
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
Medicare Part B
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
POS
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
PPO
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9040
null
cpt
rbc leukoreduced irradiated
va
Workers Comp
O
713.43
261.66
713.43
713.43
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
EPO
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
HMO
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
Medicaid
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
Medicare Part A
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
Medicare Part B
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
POS
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
PPO
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield
Workers Comp
O
204.70
37.73
63.88
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
EPO
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
HMO
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
Medicaid
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
Medicare Part A
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
Medicare Part B
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
POS
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
PPO
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
blue cross blue shield - medicare advantage
Workers Comp
O
204.70
37.73
71.68
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
EPO
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
HMO
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
Medicaid
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
Medicare Part A
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
Medicare Part B
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
POS
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
PPO
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9045
null
cpt
albumin (human) 5% 250 ml
humana - medicare advantage
Workers Comp
O
204.70
37.73
37.73
71.68
122.82


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
EPO
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
HMO
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
Medicaid
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
Medicare Part A
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
Medicare Part B
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
POS
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
PPO
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
united healthcare
Workers Comp
O
109.12
52.45
211.75
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
EPO
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
HMO
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
Medicaid
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
Medicare Part A
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
Medicare Part B
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
POS
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
PPO
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
P9047
null
cpt
albumin (human) 25% 50ml
va
Workers Comp
O
109.12
52.45
52.45
211.75
65.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
EPO
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
HMO
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
Medicaid
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
Medicare Part A
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
Medicare Part B
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
POS
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
PPO
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
aetna
Workers Comp
O
4.45
0.77
1.08
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
EPO
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
HMO
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
Medicaid
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
Medicare Part A
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
Medicare Part B
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
POS
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
PPO
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
blue cross blue shield
Workers Comp
O
4.45
0.77
1.72
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
EPO
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
HMO
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
Medicaid
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
Medicare Part A
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
Medicare Part B
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
POS
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
PPO
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
cigna
Workers Comp
O
4.45
0.77
3.15
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
EPO
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
HMO
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
Medicaid
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
Medicare Part A
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
Medicare Part B
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
POS
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
PPO
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
humana - medicare advantage
Workers Comp
O
4.45
0.77
0.77
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
EPO
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
HMO
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
Medicaid
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
Medicare Part A
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
Medicare Part B
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
POS
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
PPO
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0138
null
cpt
ferumoxytol non-esrd
tricare
Workers Comp
O
4.45
0.77
1.06
3.15
2.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
EPO
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
HMO
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
Medicaid
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
Medicare Part A
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
Medicare Part B
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
POS
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
PPO
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
aetna
Workers Comp
O
11.63
0.01
0.01
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
EPO
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
HMO
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
Medicaid
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
Medicare Part A
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
Medicare Part B
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
POS
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
PPO
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
blue cross blue shield
Workers Comp
O
11.63
0.01
2.09
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
EPO
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
HMO
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
Medicaid
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
Medicare Part A
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
Medicare Part B
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
POS
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
PPO
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q0243
null
cpt
casirivimab and imdevimab
tricare
Workers Comp
O
11.63
0.01
11.63
11.63
6.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
EPO
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
HMO
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
Medicaid
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
Medicare Part A
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
Medicare Part B
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
POS
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
PPO
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield
Workers Comp
O
96.83
12.57
12.57
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
EPO
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
HMO
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
Medicaid
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
Medicare Part A
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
Medicare Part B
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
POS
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
PPO
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4101
null
cpt
apligraf
blue cross blue shield - medicare advantage
Workers Comp
O
96.83
12.57
12.94
12.94
58.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
EPO
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
HMO
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
Medicaid
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
Medicare Part A
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
Medicare Part B
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
POS
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
PPO
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4130
null
cpt
strattice tm
blue cross blue shield
Workers Comp
O
167.52
166.42
166.42
166.42
100.51


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
EPO
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
HMO
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
Medicaid
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
Medicare Part A
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
Medicare Part B
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
POS
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
PPO
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4133
null
cpt
grafix stravix prime pl sqcm
blue cross blue shield - medicare advantage
Workers Comp
O
906.42
643.17
643.17
643.17
543.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
EPO
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
HMO
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
Medicaid
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
Medicare Part A
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
Medicare Part B
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
POS
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
PPO
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q4196
null
cpt
puraply am 1 sq cm
blue cross blue shield
Workers Comp
O
257.77
214.31
214.31
214.31
154.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
EPO
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
HMO
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
Medicaid
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
Medicare Part A
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
Medicare Part B
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
POS
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
PPO
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5101
null
cpt
injection zarxio
aetna - medicare advantage
Workers Comp
O
1.75
167.52
167.52
167.52
1.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
EPO
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
HMO
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
Medicaid
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
Medicare Part A
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
Medicare Part B
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
POS
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
PPO
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
aetna
Workers Comp
O
117.78
66.41
2099.60
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
EPO
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
HMO
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
Medicaid
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
Medicare Part A
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
Medicare Part B
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
POS
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
PPO
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5103
null
cpt
injection inflectra
blue cross blue shield
Workers Comp
O
117.78
66.41
66.41
2099.60
70.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
EPO
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
HMO
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
Medicaid
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
Medicare Part A
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
Medicare Part B
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
POS
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
PPO
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna
Workers Comp
O
32.27
8.65
344.40
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
EPO
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
HMO
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
Medicaid
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
Medicare Part A
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
Medicare Part B
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
POS
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
PPO
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
aetna - medicare advantage
Workers Comp
O
32.27
8.65
9.19
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
EPO
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
HMO
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
Medicaid
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
Medicare Part A
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
Medicare Part B
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
POS
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
PPO
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
blue cross blue shield
Workers Comp
O
32.27
8.65
13.29
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
EPO
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
HMO
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
Medicaid
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
Medicare Part A
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
Medicare Part B
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
POS
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
PPO
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
humana - medicare advantage
Workers Comp
O
32.27
8.65
8.66
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
EPO
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
HMO
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
Medicaid
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
Medicare Part A
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
Medicare Part B
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
POS
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
PPO
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5106
null
cpt
inj retacrit non-esrd use
va
Workers Comp
O
32.27
8.65
8.65
344.40
19.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
EPO
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
HMO
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
Medicaid
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
Medicare Part A
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
Medicare Part B
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
POS
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
PPO
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
aetna
Workers Comp
O
219.45
56.73
60.94
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
EPO
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
HMO
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
Medicaid
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
Medicare Part A
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
Medicare Part B
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
POS
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
PPO
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
blue cross blue shield
Workers Comp
O
219.45
56.73
70.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
EPO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
HMO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
Medicaid
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
Medicare Part A
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
Medicare Part B
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
POS
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
PPO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
humana - medicare advantage
Workers Comp
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
EPO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
HMO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
Medicaid
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
Medicare Part A
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
Medicare Part B
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
POS
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
PPO
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5107
null
cpt
inj mvasi 10 mg
tricare
Workers Comp
O
219.45
56.73
56.73
70.73
131.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
EPO
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
HMO
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
Medicaid
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
Medicare Part A
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
Medicare Part B
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
POS
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
PPO
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
humana - medicare advantage
Workers Comp
O
1845.96
301.80
309.25
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
EPO
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
HMO
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
Medicaid
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
Medicare Part A
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
Medicare Part B
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
POS
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
PPO
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5111
null
cpt
injection udenyca 0.5 mg
united healthcare - medicare advantage
Workers Comp
O
1845.96
301.80
301.80
309.25
1107.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
EPO
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
HMO
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
Medicaid
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
Medicare Part A
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
Medicare Part B
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
POS
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
PPO
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield
Workers Comp
O
280.90
5.80
5.80
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
EPO
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
HMO
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
POS
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
PPO
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5112
null
cpt
inj ontruzant 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
280.90
5.80
57.17
57.17
168.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
EPO
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
HMO
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
Medicaid
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
Medicare Part A
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
Medicare Part B
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
POS
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
PPO
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5115
null
cpt
inj truxima 10 mg
aetna
Workers Comp
O
1479.08
68.50
68.50
68.50
887.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
EPO
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
HMO
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
Medicaid
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
Medicare Part A
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
Medicare Part B
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
POS
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
PPO
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna
Workers Comp
O
285.60
73.98
5176.99
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
EPO
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
HMO
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
Medicaid
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
Medicare Part A
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
Medicare Part B
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
POS
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
PPO
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
aetna - medicare advantage
Workers Comp
O
285.60
73.98
1860.06
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
EPO
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
HMO
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
Medicaid
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
Medicare Part A
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
Medicare Part B
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
POS
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
PPO
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield
Workers Comp
O
285.60
73.98
81.65
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
EPO
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
HMO
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
POS
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
PPO
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
285.60
73.98
73.98
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
EPO
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
HMO
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
Medicaid
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
Medicare Part A
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
Medicare Part B
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
POS
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
PPO
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5117
null
cpt
inj. kanjinti 10 mg
humana - medicare advantage
Workers Comp
O
285.60
73.98
80.58
5176.99
171.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
EPO
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
HMO
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
Medicaid
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
Medicare Part A
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
Medicare Part B
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
POS
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
PPO
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield
Workers Comp
O
188.68
31.98
37.76
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
EPO
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
HMO
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
Medicaid
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
POS
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
PPO
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
blue cross blue shield - medicare advantage
Workers Comp
O
188.68
31.98
31.98
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
EPO
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
HMO
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
Medicaid
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
Medicare Part A
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
Medicare Part B
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
POS
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
PPO
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
humana - medicare advantage
Workers Comp
O
188.68
31.98
59.47
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
EPO
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
HMO
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
Medicaid
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
Medicare Part A
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
Medicare Part B
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
POS
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
PPO
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5118
null
cpt
inj. zirabev 10 mg
tricare
Workers Comp
O
188.68
31.98
57.34
59.47
113.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
EPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
HMO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
Medicaid
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
Medicare Part A
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
Medicare Part B
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
POS
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
PPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
humana - medicare advantage
Workers Comp
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
EPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
HMO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
Medicaid
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
Medicare Part A
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
Medicare Part B
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
POS
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
PPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
tricare
Workers Comp
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
EPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
HMO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
Medicaid
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
Medicare Part A
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
Medicare Part B
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
POS
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
PPO
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q5120
null
cpt
inj pegfilgrastim-bmez 0.5mg
va
Workers Comp
O
947.64
245.43
245.43
245.43
568.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
EPO
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
HMO
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
Medicaid
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
Medicare Part A
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
Medicare Part B
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
POS
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
PPO
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9956
null
cpt
inj octafluoropropane micml
blue cross blue shield - medicare advantage
Workers Comp
O
2.22
0.64
0.64
0.64
1.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
EPO
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
HMO
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
Medicaid
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
Medicare Part A
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
Medicare Part B
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
POS
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
PPO
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield
Workers Comp
O
7.11
1.01
2.20
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
EPO
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
HMO
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicaid
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part A
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part B
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
POS
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
PPO
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
blue cross blue shield - medicare advantage
Workers Comp
O
7.11
1.01
2.07
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
EPO
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
HMO
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
Medicaid
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
Medicare Part A
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
Medicare Part B
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
POS
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
PPO
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9965
null
cpt
locm 100-199mg/ml iodine1ml
va
Workers Comp
O
7.11
1.01
1.01
2.20
4.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
EPO
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
HMO
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
Medicaid
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
Medicare Part A
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
Medicare Part B
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
POS
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
PPO
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield
Workers Comp
O
3.55
0.37
0.37
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
EPO
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
HMO
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicaid
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part A
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part B
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
POS
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
PPO
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9966
null
cpt
locm 200-299mg/ml iodine1ml
blue cross blue shield - medicare advantage
Workers Comp
O
3.55
0.37
1.15
1.15
2.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
EPO
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
HMO
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
Medicaid
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
Medicare Part A
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
Medicare Part B
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
POS
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
PPO
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
aetna
Workers Comp
O
2.12
0.12
1.00
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
EPO
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
HMO
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
Medicaid
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
Medicare Part A
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
Medicare Part B
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
POS
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
PPO
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield
Workers Comp
O
2.12
0.12
1.42
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
EPO
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
HMO
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicaid
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part A
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
Medicare Part B
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
POS
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
PPO
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
blue cross blue shield - medicare advantage
Workers Comp
O
2.12
0.12
1.05
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
EPO
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
HMO
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
Medicaid
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
Medicare Part A
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
Medicare Part B
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
POS
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
PPO
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9967
null
cpt
locm 300-399mg/ml iodine1ml
va
Workers Comp
O
2.12
0.12
0.12
1.42
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
EPO
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
HMO
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
Medicaid
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
Medicare Part A
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
Medicare Part B
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
POS
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
PPO
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield
Workers Comp
O
48.14
1.43
19.17
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
EPO
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
HMO
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
Medicaid
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
Medicare Part A
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
Medicare Part B
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
POS
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
PPO
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
blue cross blue shield - medicare advantage
Workers Comp
O
48.14
1.43
1.43
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
EPO
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
HMO
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
Medicaid
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
Medicare Part A
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
Medicare Part B
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
POS
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
PPO
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9968
null
cpt
visualization adjunct
worker comp
Workers Comp
O
48.14
1.43
35.14
35.14
28.88


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
EPO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
HMO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
Medicaid
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
Medicare Part A
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
Medicare Part B
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
POS
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
PPO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
aetna - medicare advantage
Workers Comp
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
EPO
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
HMO
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
Medicaid
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
Medicare Part A
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
Medicare Part B
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
POS
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
PPO
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
blue cross blue shield
Workers Comp
O
58.98
9.84
10.18
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
EPO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
HMO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
Medicaid
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
Medicare Part A
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
Medicare Part B
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
POS
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
PPO
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
humana - medicare advantage
Workers Comp
O
58.98
9.84
10.00
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
EPO
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
HMO
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
Medicaid
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
Medicare Part A
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
Medicare Part B
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
POS
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
PPO
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
Q9969
null
cpt
non-heu tc-99m add-on/dose
united healthcare - medicare advantage
Workers Comp
O
58.98
9.84
9.84
10.18
35.39


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
EPO
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
HMO
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
Medicaid
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
Medicare Part A
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
Medicare Part B
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
POS
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
PPO
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
aetna
Workers Comp
O
2.12
0.61
0.85
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
EPO
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
HMO
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
Medicaid
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
Medicare Part A
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
Medicare Part B
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
POS
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
PPO
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield
Workers Comp
O
2.12
0.61
0.61
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
EPO
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
HMO
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
Medicaid
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
Medicare Part A
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
Medicare Part B
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
POS
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
PPO
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
blue cross blue shield - medicare advantage
Workers Comp
O
2.12
0.61
0.63
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
EPO
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
HMO
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
Medicaid
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
Medicare Part A
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
Medicare Part B
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
POS
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
PPO
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S0028
null
cpt
injection famotidine 20 mg
united healthcare
Workers Comp
O
2.12
0.61
1.59
1.59
1.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
EPO
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
HMO
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
Medicaid
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
Medicare Part A
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
Medicare Part B
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
POS
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
PPO
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
aetna
Workers Comp
O
24587.91
205.18
24397.19
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
EPO
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
HMO
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
Medicaid
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
Medicare Part A
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
Medicare Part B
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
POS
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
PPO
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield
Workers Comp
O
24587.91
205.18
10499.65
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
EPO
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
HMO
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
Medicaid
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
Medicare Part A
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
Medicare Part B
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
POS
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
PPO
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
blue cross blue shield - medicare advantage
Workers Comp
O
24587.91
205.18
205.18
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
EPO
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
HMO
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
Medicaid
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
Medicare Part A
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
Medicare Part B
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
POS
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
PPO
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
tricare
Workers Comp
O
24587.91
205.18
4481.73
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
EPO
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
HMO
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
Medicaid
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
Medicare Part A
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
Medicare Part B
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
POS
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
PPO
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
united healthcare
Workers Comp
O
24587.91
205.18
23111.69
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
EPO
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
HMO
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
Medicaid
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
Medicare Part A
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
Medicare Part B
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
POS
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
PPO
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S2900
null
cpt
robotic surgical system
va
Workers Comp
O
24587.91
205.18
4481.58
24397.19
14752.75


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
EPO
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
HMO
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
Medicaid
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
Medicare Part A
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
Medicare Part B
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
POS
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
PPO
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
aetna
Workers Comp
O
155.82
90.38
90.38
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
EPO
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
HMO
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
Medicaid
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
Medicare Part A
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
Medicare Part B
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
POS
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
PPO
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
united healthcare
Workers Comp
O
155.82
90.38
111.30
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
EPO
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
HMO
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
Medicaid
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
Medicare Part A
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
Medicare Part B
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
POS
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
PPO
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9443
null
cpt
lactation class
webtpa
Workers Comp
O
155.82
90.38
109.07
111.30
93.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
EPO
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
HMO
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
Medicaid
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
Medicare Part A
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
Medicare Part B
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
POS
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
PPO
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
S9445
null
cpt
pt education noc individ
webtpa
Workers Comp
O
104.62
69.75
69.75
69.75
62.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
EPO
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
HMO
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
Medicaid
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
Medicare Part A
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
Medicare Part B
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
POS
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
PPO
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2599
null
cpt
contact lens/es other type
blue cross blue shield
Workers Comp
O
3600.37
1002.34
1002.34
1002.34
2160.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
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
V2632
null
cpt
post chmbr intraocular lens;; Prosthetics Orthotics and Supplies
blue cross blue shield - medicare advantage
Workers Comp
O
716.56
173.98
173.98
268.00
429.94